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I
THE MAJOR SYMPTOMS
OF HYSTERIA
FIFTEEN LECTURES GIVEN IN THE
MEDICAL SCHOOL OF HARVARD
UNIVERSITY
BY
PIERRE JANET, PH.D., M.D.
SECOND EDITION
WITH NEW MATTER
THE MACMILLAN COMPANY
1920
All rifhtt reserved,
COPYRIGHT, 1907 AND 1920,
BY THE MACMILLAN COMPANY.
Set up and electrotyped. Published June, 1907.
Second Edition Published, November, 1920.
NortaooU
J. 8. Cashing Co. — Berwick & Smith Co.
Norwood, Mass., U.S.A.
PROFESSOR JAMES JACKSON PUTNAM
OF HARVARD UNIVERSITY
THESE LECTURES ARE AFFECTIONATELY
DEDICATED
PREFATORY NOTE
ON the occasion of the inauguration of the new
and magnificent buildings of the Medical School of
Harvard University in Boston, President Eliot and
Dr. J. J. Putnam, professor of the diseases of the
nervous system, asked me to deliver before the stu-
dents some lectures about pathological psychology.
I greatly appreciated this honour, and tried to sum
up before the American students some elementary
psychological researches about a well-known disease,
Hysteria, in order to show them how the study of the
mental state of the patient can sometimes be useful
to explain many disturbances and to give some unity
to apparently discordant symptoms. So the follow-
ing fifteen lectures were given in the Harvard Medi-
cal School between the fifteenth of October and the
end of November, 1906. Some of these lectures
were also delivered in Johns Hopkins University at
Baltimore, at the request of Professor J. M. Baldwin,
and in the medical school of Columbia University in
New York, at that of Professor Allen Starr. I avail
myself of the opportunity of this publication to offer
my best thanks to these professors and their col-
leagues for their invitation and hearty welcome.
Let me, too, thank here my friend M. Edouard
Philippi, for the very useful help he gave me in
drawing up these lectures in a foreign language.
CONTENTS
PAGE
PREFATORY NOTE vii
LECTURE I
THE PROBLEM OF HYSTERIA .
LECTURE II
MONOIDEIC SOMNAMBULISMS 22
LECTURE III
FUGUES AND POLYIDEIC SOMNAMBULISMS ... 44
LECTURE IV
DOUBLE PERSONALITIES 66
LECTURE V
CONVULSIVE ATTACKS, FITS OF SLEEP, ARTIFICIAL
SOMNAMBULISMS 93
LECTURE VI
MOTOR AGITATIONS — CONTRACTURES . . . .117
i
LECTURE VII
PARALYSES — DIAGNOSIS 138
ix
x Contents
LECTURE VIII
PAGE
THE PSYCHOLOGICAL CONCEPTION OF PARALYSES AND
ANESTHESIAS . .159
LECTURE IX
THE TROUBLES OF VISION . . . . . .182
LECTURE X
THE TROUBLES OF SPEECH 208
LECTURE XI
THE DISTURBANCES OF ALIMENTATION .... 227
LECTURE XII
THE Tics OF RESPIRATION AND ALIMENTATION . . 245
LECTURE XIII
THE HYSTERICAL STIGMATA — SUGGESTIBILITY . . 270
LECTURE XIV
THE HYSTERICAL STIGMATA — THE CONTRACTION OF
THE FIELD OF CONSCIOUSNESS — THE COMMON STIG-
MATA 293
LECTURE XV
GENERAL DEFINITIONS 317
INDEX . 339
INTRODUCTION TO THE SECOND
EDITION
THE kind reception these lectures on hysteria have
met with encourages us to publish a second edition
of this work. It does not seem to us very useful to
modify it profoundly, for the interest of a scientific
work resides almost always in the date a't which it
was drawn up, and one should not confusedly mix
the ideas of one period with those of another. I only
wish to show in a short preface that certain notions
set forth in these lectures of 1906 have spread very
much since that date and have played a great part in
the interpretation of hysteria. I should also like to
show in what direction I have been led myself, in
my other works published since that time, to develop
certain of my preceding interpretations.
One of the chief conceptions that have directed my
first researches on hysteria is that of the importance
of fixed ideas in this disease : many of the most appar-
ent symptoms recognized in the attacks, the somnam-
bulisms, the disturbances of motility and sensibility,
are but an outer manifestation, an expression of a
conviction the patient keeps in his mind. In one of
my first works on hysteria, published in I892,1 I
classed all these various accidents, the paralyses, con-
tractures, dysaesthesias, etc., in the chapter on " fixed
1 L'ttat mental des hysUriques, 1892, II, p. 56; 2d ed., F. Alcan,
1911, p. 239.
ri
xii Introduction
ideas." It is equally this interpretation that takes
up the greatest place in these lectures on "The Major
Symptoms of Hysteria."
It is not without interest to remark that this con-
ception has become the starting-point of the now most
widespread theories which, under the name of "pithia-
tism," sum up the whole hysterical disease by that
disposition to auto-suggestion which, according to
them, is capable of transforming the ideas of the sub-
ject into real accidents. In these theories, the hyster-
ical phenomena have the great character, common to
all of them and existing only in them, that they are
the result of the very idea the patient has of his
accident: "the hysteric patient," M. Bernheim al-
ready said, " realizes her accident as she conceives it."
This view is really interesting and has surely some
preciseness, for there is not any organic disease nor
even any other mental disease in which matters go
in this way. Nobody will maintain that in a maniacal
fit the patient is agitated because he is thinking of
agitation. This development of the accidents by a
mechanism always identical to that of suggestion
would therefore be something peculiar to hysteria
and could evidently serve to define it.
Far from contradicting the pithiatic interpretation
of hysteria, which in my first writings I had already
proposed to apply to many of the symptoms of the
neurosis, I should now be inclined to believe that it
ought to be still extended. One of the characters of
the present conception of hysteria depends on the
milieu in which it has been particularly studied, I
Introduction xiii
mean the Clinic of the Salpetriere. This Clinic was
much more neurologic than psychiatric, and was
chiefly devoted to the study of the somatic accidents,
of the paralyses, the contractures depending on
diseases of the nervous system. This is what has
determined the direction of the studies on hysteria :
what has been considered by preference in this disease
is the paralyses, the contractures, the disturbances
of the elementary sensibilities, as if these accidents
constituted the essential of the neurosis. But if
at the present time we agree that hysteria is before
everything else a mental disease consisting chiefly
in an exaggeration of suggestibility, we shall have to
connect more and more with it accidents properly
mental in which this exaggeration is also manifested,
impairments of the memory, fixed ideas without
somatic manifestations, and even deliriums in which
auto-suggestion equally plays an evident role. The
old hysteric deliriums are nearly forgotten now;
it will perhaps be well to restore them, calling them,
if one pleases, pithiatic deliriums : it will enable us
better to understand a certain number of rather badly
interpreted mental disturbances.
It is none the less true that this conception of the
hysterical neurosis is far from complete, and the re-
strictions already laid on them in these lectures
(p. 326) seem to me to have kept all their importance.
I had occasion to insist upon this discussion in my
little book on "Les nevroses" (Flammarion, 1909,
P- 325)) which, I hope, will soon be translated into
English. To be able to explain a symptom by auto-
xiv Introduction
suggestion, one must be able to demonstrate that the
idea of this symptom has been predominant in the
mind of the subject before the appearance of the
symptom, that the idea has been automatically trans-
formed into a belief, and that this belief has played
a part in the development of the symptom. Now it
is easy to show that such a demonstration has not
been made and cannot be made in every case. The
fundamental psychological characters of the neurosis,
the disappearance of the activities of the higher order,
the laziness of the mind, the disposition to absent-
mindedness, the contraction of consciousness and the
suggestibility itself cannot be considered as phenomena
of pithiatism. No doubt a great share must be given
to suggestion, but it should not be forgotten that in
a normal mind suggestion does not give rise to serious
accidents, and it is necessary to explain on what de-
pends its power, abnormal in certain minds, for it is
that which characterizes the hysterical malady.
In my early writings and in these lectures on "The
Major Symptoms of Hysteria," there was another
notion to which I gave an important r61e to play, the
notion of the contraction of the field of consciousness
and that of subconscious psychological phenomena.
I showed in these lectures that one of the chief
characters of hysterical anesthesias, distractions,
amnesias, paralyses was not the disappearance of a
psychological phenomenon, but a particular trans-
formation of this phenomenon in consciousness. It
ceased to be a part of personal consciousness and no
longer existed but in another grouping of psychological
Introduction xv
phenomena which constituted the sub-consciousness
or sometimes the second consciousness of the somnam-
bulisms or of the medianimic writings.
These new notions have also had a remarkable
development in the theories that have tried to ex-
plain the hysteric neurosis through conversion, sym-
bolism, "driving back." Certain ideas, certain recol-
lections present themselves to the mind of the sub-
ject in a painful manner, for they hurt his sensibility
and are in opposition with his moral feelings. Dis-
satisfied with having such thoughts in his mind, the
subject makes great efforts to get rid of them: he
struggles in every way with these ideas, and when
they present themselves to his consciousness, he
stops them, he does not allow them to develop, to
realize themselves in acts and clear thoughts, and
endeavours not to notice them, to forget them. "Driv-
ing back," it was said, forms a part of the systems
of defence of the organism. The ideas thus driven
back became the subconscious phenomena and brought
about in this manner various pathological disturb-
ances.
In my last work, "Les medications psychologiques"
(F. Alcan, 1919, Vol. II, pp. 256-262), I had occasion
to study these theories of driving back, to show their
importance and their relations to the early writings
on subconscious phenomena. In that work I ex-
amined a remarkable case of left hysterical hemiplegy,
in which, after a tragical event relative to his left side,
the subject evinced singular horror for this side;
the driving back, which seemed here obvious, could
xvi Introduction
be regarded as the determinative cause of the hemi-
plegy itself. I tried to show likewise that phe-
nomena analogous to driving back can play an in-
teresting part in the formation of certain impulsions,
of certain obsessions, particularly in the monstrous
and sacrilegious obsessions. These new studies
seemed therefore to continue the preceding ones in
the same direction and sometimes to complete them
in a useful manner.
Nevertheless, as the theories of pithiatism seem to
me insufficient, so, and wiih still stronger reason, I
consider the theories of "driving back" as incapable
of giving a complete explanation of the hysterical
neurosis. The facts that are interpreted in this way
can often be understood in another manner. With
regard to the case of hemiplegy to which I have just
referred, I have shown that the horror of the subject
for his left side could very well be considered as the
consequence of the incipient paralysis instead of being
its starting-point. But the most important problem
concerns driving back itself, as a moment ago it
concerned suggestion. With normal individuals, the
regret, the scorn for certain ideas, the driving back is
far from bringing on analogous pathologic disturbances.
To produce such results, the driving back must al-
ready be exaggerated and transformed by the disease.
Driving back, such as it is presented in these theories,
seems to me to be a symptom of the malady, as sug-
gestion did before, and it requires itself an explanation.
To get beyond these first interpretations, to make
new progress in these studies of psycho-pathology, it
Introduction xvii
would be useful to analyze more thoroughly these
symptoms, which are too readily taken as starting-
points, and with which one tries to link all the other
phenomena without explaining them themselves. It
would be necessary, if I mistake not, better to under-
stand the nature of these phenomena of suggestion,
of subconsciousness, of driving back, and the condi-
tions that bring about their exaggerated develop-
ment. This is why in my last writings, which at-
tempt to complete these lectures on hysteria, I
have begun again the analysis and the interpretation
of the psychological phenomenon of impulsion, which
seems to me to constitute the essential part of all
the preceding facts.
The question here is of the problem of voluntary
action with individuals capable of conceiving the idea
of an action before executing it, and capable of con-
necting in various ways the idea of the action with the
action itself, that is to say with the motion of their
limbs; in a word, the question is of the problem of
ideo-motor activity. Will and belief, which are the
two forms of this activity, are analogous mental
operations : in will, the execution of the act is im-
mediate, as soon as the idea is accepted, the act is
realized by the motion of our limbs; in belief, the
question is also of the execution of an act, but the
conditions of this act not being immediately present,
the question is of a deferred and conditional act. To
believe that it is raining outside is to make up one's
mind to open one's umbrella if one goes out, but
is not to open it immediately in the room. In
xviii Introduction
both these forms of action, the essential is the estab-
lishment of a connection between the idea of the act
and the act itself, either immediate or deferred, it is the
operation of assent.
With normally evolved and healthy individuals,
this assent can be performed in a perfected manner,
thanks to the mechanism of reflection. The ideas of
different actions then present themselves to the mind,
but they are stopped, suspended in their develop-
ment, and are not immediately transformed into wills
or beliefs. They are compared, opposed to one an-
other ; in this comparison, one does not only take into
account the present momentary force of the different
ideas, each of which is more or less accompanied with
desire. Reflection calls up moreover the still latent
force of the tendencies that each idea represents. It is
only after a longer or shorter deliberation, in which
these deep forces are appreciated, that one of these
ideas is adopted by assent and allowed to develop into
will or belief. The wills or beliefs thus brought about
by reflective assent represent the real forces of our
tendencies, all of which have been called up and
weighed ; they are exactly conformable to our whole
personality, they are accompanied in the highest de-
gree with the feelings of personality and reality.
Such assents are difficult and require mental activity
of a high order. In other circumstances, they may be
replaced by assents that, while apparently analogous,
are brought on in a simpler and easier way. Reflec-
tion does not come in to stop the ideas, to investigate
the latent force of the tendencies they represent.
Introduction xix
The assent is immediate, and is simply induced by the
present and momentary force that each idea brings
with it, whatever may be the accidental circumstance
which gives it this force. Then it is that one wills
and believes simply what one desires, what pleases
one momentarily, what is strongly presented to one's
mind by an outer influence. The question is still
of wills and beliefs, but these phenomena are immedi-
ate and irreflective. They still bring about acts,
and even acts that are sometimes more violent, and
more tenacious, but they do not in the same manner
involve the whole personality and do not bear with
them, like reflective beliefs, the feeling of reality.
It is such wills and such beliefs that are often ac-
companied with the feelings of automatism, deperson-
alization and irreality.
It is easy to observe that certain minds seem to be
fixed in one or the other of these modes of assent.
Selfish minds, capable of well understanding personal
interest and of well calculating it, utilize almost ex-
clusively the reflective mode ; weak minds, incapable
of resisting their momentary desires, docile to every
influence, hardly get beyond the second. But an-
other psychological state is particularly interesting,
namely that of the minds that, according to circum-
stances, oscillate between these two modes of assent.
Certain individuals are in reality capable of reflection,
as they are capable of discussing with an adversary
who contradicts their opinions. But they cannot
sustain the discussion for a long while. If the ad-
versary insists for some time, their resistance is very
xx Introduction
soon exhausted and they give up the struggle to adopt
the strange opinion. Likewise they begin the re-
flection, which is a sort of inner discussion, then they
get tired, and, without concluding the deliberation they
have begun, they allow themselves to be carried away
by some desire or other. Impulsion appears to me to
consist essentially in this insufficiency of reflection,
which stops at a more or less advanced stage of its
evolution and is transformed into immediate assent.
Suggestion, obsession, exaggerated driving back are
varieties of impulsion. These phenomena arise when
different phenomena bring about the rapid exhaustion
of reflection and the appearance of immediate and
elementary assents.
We find here once more the fundamental phenom-
enon which plays an important part in all the disturb-
ances of the mind, the decay, the lowering of the mind,
which passes from a form of higher activity to a lower
form. This phenomenon is met with in hysteria as
well as in all the psychoses, and the study of hysteria
should not be separated from the more general study
of the psychological depressions. The defect of most
of the preceding writings is that the early authors have
too much considered hysteria in itself, because at the
outset of psycho-pathology the study of psychological
phenomena appeared particularly easy in this disease.
At the present day we must extend the studies in
psycho-pathology and replace hysteria in the ensemble
of the mental diseases, and in particular put it in
its place in the table of the psychological depressions,
of which it presents us only a particular case.
Introduction xxi
If we attempted this study, which is very difficult
nowadays, we might say that hysterical patients, by
reason of their heredity, by the evolution of puberty,
in consequence of various intoxications, various ex-
haustions, under the influence of fatigues, of emotions,
which are phenomena analogous to fatigues, have
fallen into a very enduring but not very deep depres-
sion, reaching the level of mental laziness. In my
lectures at the College de France on these oscillations
of the mind, I presented sadness as the first degree of
depression, and laziness as the second. In that state
of laziness, the patients are still capable of reflection,
which disappears only in the third degree, that of
aboulias, but they are incapable of the rational or
"ergetic" acts in which the individual through his
efforts adds energy to rational or experimental ideas,
powerless by themselves. At the level of mental lazi-
ness, the subject is passionate, selfish, lazy, and given
to telling lies, for these are the essential features that
psychological activity assumes in this form of de-
pression, but he has not yet any characteristic acci-
dents.
Under different influences which bring on greater
exhaustion, there is from time to time with these
patients a period of deeper depression. The fall is
often manifested by particular symptoms : the con-
vulsive attacks, the crises of tears, the agitations, the
megrims themselves are often phenomena of discharge
and relaxation. The subject has gone down one de-
gree, he remains at the level of aboulia. He has lost
the mental syntheses that constitute reflective will
xxii Introduction
and belief, he simply transforms into automatic wills
and beliefs the tendencies which are momentarily
the strongest. It is at that moment that the sugges-
tions, the fixed ideas, the deliriums arise which com-
plicate the disease during longer or shorter periods,
till the subject reascends to the preceding level, that
of mental laziness.
In all the mental diseases, oscillations of this kind
are observed which bring about falls to more or less
inferior levels and leave the subject for a longer or
shorter time at the level to which he has fallen. The
hierarchic table of the various activities will be es-
i
tablished one day, and such or such a psychosis will
be determined by the level to which the depression
falls in the various phases of this disease ; in a word,
this disease will be determined by drawing the curve
of the psychologic depression in the evolution of the
disease, and by showing that this curve is characteris-
tic. In many psychoses, in confusions, in toxic
deliriums, in dementias, the curve descends very low,
as far as the level of elementary intellectual activities
or of reflex activities. But we may give the name of
hysteria to a certain curve of mean depth which shows
frequent oscillations between mental laziness and a
more or less profound aboulia. It is these oscilla-
tions, these depressions to a mean depth that account
for the insufficiencies of the mental synthesis and the
various impulsions which psychologic analyses had
first shown us under the apparently physical symptoms
of hystericals.
Such are, briefly summed up, the researches that
Introduction xxiii
in my last works I have tried to add to the first
investigations presented in these lectures. I have
simply indicated them in this preface to encourage the
readers to consider these lectures as a starting-point
and to go beyond this old teaching through their own
studies.
PIERRE JANET
Paris, April 10, 1920.
THE MAJOR SYMPTOMS OF
HYSTERIA
LECTURE I
THE PROBLEM OF HYSTERIA
The interest and importance of studying hysteria — The
philosophical and the medical point of view — Brief
account of the evolution of the studies about this disease —
The necessity for the psychological study of the neuroses —
The psychological type of hysteria
GENTLEMEN: President Eliot and the Professors
of the great University of Harvard have determined
to celebrate the opening of the new buildings of your
Medical School by putting into practice a beautiful
and great thought. They have determined to invite
to come among them foreign professors, and have
begged them to expose before you the ideas and teach-
ings they give in other countries. It is a mode of
teaching which is very often used in American uni-
versities but, unfortunately, is rarely applied in France.
It may have the most beautiful results for the teaching
of youth, for the development of science, and for the
union of the various nations, which is in our time the
great aim of all true civilizations. Unhappily the
application of this beautiful method is very difficult,
for all depends on the choice of that foreign professor
2 The Major Symptoms of Hysteria
called momentarily to teach among you. No doubt
I congratulate myself very much upon the choice
which has been made; it is for me a great honour,
it gives me an opportunity to see again a town of which
I am very fond, and to try to diffuse among you some
ideas to which I hold. But I dare not congratulate you
upon this choice, for I am afraid my ignorance of your
methods of teaching, and above all my ignorance of
your tongue, will make these lectures very hard to
understand and very painful to hear. First, I make
you my apologies; then, I wish you may overcome
this bad luck and forget as much as possible the in-
correctness and strangeness of my language. This
done, let us all do our best — you to understand me
tolerably well and to draw from these lectures some
notions of what interests French students; I, to speak
nearly intelligible English and to give you as favourable
an impression as possible of the psychological study
of nervous diseases in the French universities.
With the approval of President Eliot and of Pro-
fessor James J. Putnam, I have chosen as the subject
of these lectures the study of that nervous and mental
disease called Hysteria. The reason of this choice
is that from many points of view this study seems
to me pretty well to answer the wish of the professors
who called me. When a foreign professor is asked
to express his ideas in another country, he is expected
to expose one of the most characteristic studies of his
The Problem of Hysteria 3
native land, just as, when we have landed in a new
country, we seek to taste the dishes that characterize
its cookery. Well, it seems to me that what has been
most characteristic in France for a score of years in
the study of nervous diseases is the development of
pathological psychology. No doubt, the clinic and
anatomic study of these same diseases is very honour-
ably represented by French names, but this study has
developed in the same way in other countries, and I
think you have not much for which to envy us in this
matter. Psychological studies, properly so called,
especially the studies of psychological measures, have
developed in Germany and in America more than in
France, and it is not here, near Professor Miinster-
berg's laboratory, that it would be well to come and
deliver a lecture on this subject. But it seems to me
that in France, under the influence of two of my masters,
whose names I like to recall, — Charcot and Professor
Ribot, — was realized an interesting union between
two studies which were for the most part separated
before. Beautiful natural experiences have been bor-
rowed from mental pathology which strongly illumi-
nate the problems of psychology; on the other hand,
notions of experimental psychology have been made
use of in order to understand and sometimes to treat
patients' mental disturbances. I should be happy to
make you feel how interesting is this new study, which
seems to me to have very good prospects.
Among these studies of pathological psychology,
I determined on taking that of a particular nervous
disease, Hysteria; I think it is by this one that one
4 The Major Symptoms of Hysteria
should begin nowadays; for this we have historical
and scientific reasons. Look back to the time of the
first works of Charcot, Ribot, and their pupils. Cast
a glance at the innumerable works which, twenty years
ago, determined that current of researches. Remem-
ber the names of Mesnet, Pitres, Paul Richer, Charles
Richet, Binet, Fe're', Marie, Grasset, Gilles de la
Tourette, Brissaud, and in foreign countries, of Del-
boeuf, Moebius, Breuer, Freud, Morton Prince,
etc. Remark what was, by a kind of singular common
understanding, the subject of all their works. No
doubt they seemed, like Professor Ribot, to speak of all
possible mental diseases and to seek for mental dis-
turbances in all the forms in which they present them-
selves. Now and then, it is true, they devoted a few
lines to idiocy or insanity ; but if you read their books
again, you will see that, whatever the matter is, " Mala-
dies de la Me"moire," "Maladies de la Volonte*,"
"Maladies de la Personnalite"," they always speak
of localized amnesias, of alternating memory, which
in reality are only to be met among hysterical som-
nambulisms ; of irresistible suggestions, hypnotic cata-
lepsias, which are, as I will try to prove to you, noth-
ing but hysterical phenomena; of total modifications
of the personality divided into two successive or simul-
taneous persons, which is again the dissociation of
consciousness in the hysteric. Besides all these works,
pathologic psychology owes very much to the con-
siderable movement concerning hypnotism, which
took place during a few years. It is certain that the
works of Charcot, Bernheim, Forel, and so many others
The Problem of Hysteria 5
had the greatest influence on the development of this
new science, but now that the quarrels of other times
are somewhat appeased, everybody will probably
recognize a fact which I hope also to be able to prove
to you ; namely, that in reality it is only among hys-
terical patients that this hypnotism is to be found in
any marked degree. I will not raise now the difficult
problem of deciding whether all the people who can
be hypnotised must be called hystericals, but I believe
almost every good observer will agree with me that the
best studies about the clearest cases of artificially in-
duced somnambulism and about its psychological proper-
ties were made on hysterical subjects. Consider even
the somewhat adventurous authors who have sought to
draw attention to particularly strange phenomena and
who, by the curiosity they have raised, have had a
share in the development of the same researches;
remember the studies on psychic polarization, on trans-
fer, on marked points suggestions (suggestions a points
de rep&re), on unconscious acts, etc. These studies
have always had for their starting-point hysteric phe-
nomena as equivalences and anesthesias. In a word,
if any interest is given to the development of that patho-
logical psychology which has been growing these twenty
years, it ought to be recognized that this interest has
for its object a special disease : Hysteria.
No doubt, such exclusive fondness for this study was
rather exaggerated, and all the psychologists who, for
some time, in imitation of the masters, studied the
hysteric, were somewhat like the sheep of our Panurge.
It was an exaggeration to think that pathological psy-
6 The Major Symptoms of Hysteria
chology could not be studied on other patients. Dr.
Fe*r£ was somewhat mistaken when he called hystericals
the frogs of experimental psychology. As in physiology
the frog is not an absolutely necessary animal for our
experiments, so the hysteric patient is not the only one
worthy of psychological researches. We are even cer-
tain to-day that the hysteric offer many drawbacks,
and many studies have been made on other diseases.
However, it is true that there were certain practical
reasons justifying this choice at the beginning of this
kind of studies; and these practical reasons are still
the same for you. The psychology of the hysteric
patient, though full of difficulties and obscurities, is
surely simple. It is a question of measure ; all I want
to say is that we are nowadays quite unable to under-
stand, to express in formulas and in laws, what an in-
sane person feels. We can hardly connect together by
general laws the different facts observed in melancholic
delirium or in the delirium of persecution. On the
contrary, the various accidents of hysteria, though so
different in appearance, are easily brought close to one
another owing to common characters. We can dimly
see some general laws, about the formula for which we
hesitate, but of whose existence we have a suspicion.
That is, after all, the reason that explains the character
of the discussion about hysteria nowadays. While no-
body endeavours to give or to discuss a general defi-
nition comprising all the phenomena of epilepsy or
melancholia, there are now a great number of authors
who propose to explain in a few words, in a single
definition, all the pathology of hysteria. In short, I
The Problem of Hysteria 7
was right in saying to you that the psychology of this
disease seems now to be simpler than the conception
of other mental diseases. It is the reason why I told
you that the psychology of this disease is simple. To
this primordial reason are added practical reasons : the
hysteric are patients who are easily managed, who talk
willingly, who are not dangerous, on whom we can
experiment without any great fear, and who, lastly, like
to be observed, and readily lend themselves to examina-
tion. Such are the reasons why the first studies were
devoted to this kind of patients, and, in following the
historical order, we also follow the practical order,
which leads us to begin with the simplest and easiest
disease.
II
Do not think, however, that this choice of the study
of the hysteric is only justified by an historical chance
and by reasons of convenience. The study of these
patients, if happily it is a rather easy one, is at the
same time very important, both from the philosophical
and scientific and from the medical and practical point
of view. I am convinced that in our times, every well-
educated man wishing to have an opinion on moral and
philosophical problems ought to know something of this
singular mental disease, for it has played a considerable
part in the history of all religions and superstitions,
and it still plays a very important part in the most
attractive moral questions. A great French alienist,
Moreau de Tours, was in the habit of saying that all
the great things accomplished in the world have been
8 The Major Symptoms of Hysteria
accomplished by mad people. It is perhaps some-
what exaggerated, but it is nevertheless true that most
great creeds have spread by means of the emotion
caused by surprising phenomena, which have always
been due to hysteric people. In the development of
every great religion, both in ancient and in modern
times, there have always been strange persons who
raised the admiration of the crowd because their nature
seemed to be different from human nature. Their
manner of thinking was not the same as that of others ;
they also had extraordinary oblivions or remembrances,
they had visions, they saw or heard what others could
not see or hear. They were illumined by odd con-
victions; not only did they think but they also felt in
another way than the bulk of mankind; they had an
extraordinary delicacy of certain senses joined to ex-
travagant insensibilities which enabled them to bear
the most dreadful tortures with indifference or even
with delight. Not only did they feel but they also lived
otherwise than other people; they could do without
sleep, or sleep for months together; they lived without
eating or drinking, without satisfying their natural
needs. Is it not such persons who have always excited
the religious admiration of peoples, whether sibyls,
prophets, pythonesses of Delphi or Ephesus, or saints
of the Middle Ages, or ecstatics, or illuminates ? Now
they were considered as worthy of admiration and
beatified, now they were called witches or demoniacs
and burnt; but, at the bottom, they always caused
astonishment and they played a great part in the
development of dogmas and creeds.
The Problem of Hysteria 9
Well, all these phenomena, as you know already, are
the usual symptoms of hysteria, and there is not, from
this point of view, a disease which has played so great
a part in history. If I am not mistaken, it is still
exactly the same now: we have changed only in ap-
pearance. We beatify but few saints and we burn
but few demoniacs, yet we have not forgotten them;
they have become our somnambulists and mediums,
and every time we want to throw some light on the
mysteries of our destiny, to penetrate into the unknown
faculties of the human mind, to whom do we appeal?
Whom do we take as a subject of observation? Is it
an ordinary person, a person in good health, whom we
ask to foresee the future or to talk with the dead ? No ;
it is a neuropathic patient, insensible to the things
of this world, but whose sensibility is overexcited in a
certain direction ; medically speaking, it is a hysteric
person.
Understand me well. I do not mean at all to tell
you that these studies are warped by this, any more
than I deny the sanctity of a personage of the Middle
Ages whom I diagnosticate as hysteric. A hysterical
person may be a saint ; a hysterical person may have a
wonderful lucidity: that is undeniable. I only want
you to be warned of what happens when you have to
judge facts of this kind. When we have to appreciate
facts which are out of our habitual observation and look
wonderful, it is a material point to know well in what
conditions they present themselves. Now in the ques-
tion we are considering, one of these conditions, the
most serious one, is the mental state of the persons in
io The Major Symptoms of Hysteria
whom such facts are observable. So you must know
that such persons are hystericals, and be accustomed to
the laws ruling the minds of hystericals. Perhaps there
may be some cases in which this ascertainment does
not diminish the interest taken in the phenomenon, but,
believe me, it mostly takes away a great part of the
wonderful. To judge these moral and philosophical
problems, it is indispensable to study thoroughly this
disease of the mind.
This remark is truer still if you consider the subject
from a medical and practical point of view. You who
have chosen the medical career and will have to attend
patients belonging to every class of society: bear in
mind that you will constantly meet with neuropathic
phenomena connected with this group of neuroses and
that you will commit the most dangerous mistakes if
you are not very well accustomed to the aspects and
evolution of hysteria. It was the fashion for a certain
time to say that hysteria was a very rare disease; you
know that it had a bad reputation, that a kind of dis-
honour was attached to this word, and that people tried
to persuade themselves that this shameful disease was
not of frequent occurrence. By a kind of international
irony, people were willing to admit, after the innumer-
able studies made by French physicians, that hysteria
was frequent only among French women, which as-
tonished nobody, on account of their bad reputation.
Do not believe this nonsense. American women are
terribly like French women. I was not astonished there-
fore, when, two years ago, at the Chicago County Hospital
and at the Boston City Hospital, some kind fellow-
The Problem of Hysteria n
physicians immediately showed me hysteric women,
humorously adding that they were quite the same as
those of La Salpetriere. The difference of races is also
one of those silly things which the human mind has
much difficulty in getting rid of. All civilized nations
are now the same: we have the same mind and the
same body, and, it must be recognized, the same miseries.
If the hysterical seemed to be less numerous in other
countries, it is first because physicians did not recognize
them, then because they would not give them their real
appellation. When medical instruction is more general
in this matter, when prejudices have vanished, it will
probably be acknowledged that in this matter, as in
many others, the other nations have no reason for
envying France.
So you will often meet with hysterical people. You
will call them neurasthenic for the family, if you like.
I don't care. I only wish that you should at least know
what is the matter. You must be able quickly to
recognize this disease, in order to foresee its evolution,
to provide against its dangers, and immediately to begin
a rational treatment. This early diagnosis is much
more important still from another point of view: it
will keep you, allow me to tell you plainly, from making
blunders. It is perhaps not very serious not to recognize
a hysterical accident and not to treat it ; but what is
always very serious is to mistake a hysterical accident
for another one, and to treat it for what it is not. You
cannot imagine the medical blunders, and too often
also the medical crimes, committed in this way. One
of the greatest difficulties in the medical art and one of
12 The Major Symptoms of Hysteria
the greatest misfortunes of patients is that hysterical
diseases are only well characterized from the moral
point of view, which usually is not examined at all ; that
they are very badly characterized from the physical
point of view, and that they are uncommonly similar to
all kinds of medical or surgical affections, for which
they are easily mistaken. Contractures, paralyses,
anesthesias, various pains, especially when they are
seated in the viscera, may simulate anything ; and then
you have the legion of false tuberculoses of the lungs,
of false tumours of the stomach, of false intestinal ob-
structions, and above all, of false uterine and ovarian
tumours. What happens as to the viscera also exists
as to the limbs and the organs of the senses. Some
hysterical disturbances are mistaken for lesions of the
bones, of the rachis, for muscular or tendinous lesions.
Then the physician interposes, frightens the family,
agitates the patient to the utmost, and prescribes ex-
traordinary diets, perturbing the life and exhausting the
strength of the sick person. Finally, the surgeon is
called in. Do not try to count the number of arms cut
off, 'of muscles of the neck incised for cricks, of bones
broken for mere cramps, of bellies cut open for phantom
tumours, and especially of women made barren for pre-
tended ovarian tumours. Humanity ought indeed to
do homage to Charcot for having prevented a greater
depopulation. These things no doubt have decreased,
but they are still done every day. Not long ago I saw
a patient who had had an eye excised and the optic
nerve cut out for mere neuropathic pains. If I could
only, by calling your attention and interest to the knowl-
The Problem of Hysteria 13
edge of this disease, contribute to diminish the number
of these medical crimes, I should already have attained
a very important result.
Ill
In order to be able to enter upon the study of hysteria
in a profitable way, allow me, before I end the intro-
duction, to summarize in a few words the history of the
studies which have been made on this disease. We are
not isolated in our studies : we come after generations
of other students, and we always ought, before we begin
our own researches, to try to see our way exactly. We
ought to see at what point of medical history we are
standing, what has been done and well done before us,
what we have not to begin again. We ought to realize
the difficulties that stopped our predecessors, in order
to add our efforts to theirs, and to make some steps
forward in the way they have laid down for us. The
history of these studies would be a very long one, for
they began in the remotest antiquity: Democritus
already has his theory about hysteria. But I think
that we can summarize this long history in a few
words by establishing a few great divisions, and I pro-
pose to you to adopt three great divisions. At first this
history was anecdotical and descriptive : it is a period
of curiosity and of somewhat uneasy and uncritical
admiration. It is the period of sibyls, witches, con-
vulsionists of all kinds, and of miscellanies of surprising
facts about convulsions, somnambulisms, resurrections
of lethargic people, extraordinary fastings, miraculous
14 The Major Symptoms of Hysteria
wounds, etc. The second period, which, in reality,
began very late, only in the nineteenth century, might
be called the clinical period; then physicians sought,
above all, to give a medical character to this disease,
to distinguish it from other maladies, and to recognize
the phenomena that appertain to it. It is a kind of
clearing away and classification. The third period,
which is quite contemporary, deserves to be called the
psychological period; for, right or wrong, it is among
mental phenomena that, for these thirty years, the
interpretation has been sought of these innumerable
phenomena which our first ancestors had only described
and which their successors contented themselves with
classifying. Later, perhaps, there will come an ana-
tomical and physiological period, but, in my opinion, it
does not yet exist.
A word only about each of these great stages. In the
first, it is sufficient to remind you of the names of Plato,
Hippocrates, Celsus, Galienus, ^Etius, of the authors
who, in the middle ages, described possessions, choreas,
epidemics of tarentism. Among them are Ambroise
Pare* and Fernel. A little later we have to cite Charles
Lepois, who gave in the seventeenth century one of the
best descriptions; Sydenham, who made known the
hysterical nail, coughing, vomiting, and oedema ; Raulin
(1758), who supported the opinion of Sydenham, and
was one of the first to maintain that there were hysteric
men; Witt (1767), Sauvage (1760), Astruc (1761), and
Pomme (1760-1782), who discussed this strange problem.
This descriptive period was, in fact, disturbed by a
puerile and dangerous conception which vitiated all the
The Problem of Hysteria 15
studies and made any attempt at an interpretation im-
possible. You know the old revery of Plato in the
Timaus: "The matrix is an animal which longs to
generate children. When it remains barren for a long
time after puberty, it finds it difficult to bear, it feels
wroth, it goes about the whole body, closing the issues
for the air, stopping the respiration, putting the body
into extreme dangers, and occasioning various diseases,
until desire and love, bringing man and woman together,
make a fruit and gather it as from a tree." This pretty
little story was for half a score of centuries the only
interpretation of hysteria, and still originated all the
foolish ideas expressed by Louyer de Villermay in 1860.
You may guess the part played in this respect by the
abdominal pains seated at the level of ovaries, by the
movements of the hysterical nail, by the suffocations of
the patients during their fits. As hysteria required an
uterus (va-repov), its existence was not admitted in
men, and the first serious discussions bore on the exist-
ence of masculine hysteria.
The recognition of this disease in men changed the
old conception of hysteria and determined an ensemble
of more precise clinical researches. Without pretend-
ing to any chronological precision, we place at the
beginning of the nineteenth century the inauguration
of the second and truly clinical period. It is sufficient
to remind you of the names of Georget (1821), of Hufe-
land in Germany (1836), of Brachet and of Landouzy
in France (1845), °f Duchenne de Boulogne (1855), of
Legrand du Saulle (1860). But I must insist on the
beautiful book of the English physician Brodie (1837),
\6 The Major Symptoms of Hysteria
who described the sensitive and motor disturbances in
the articulations, and who has given his name to an
hysterical accident, the knee of Brodie. We must accord
a good place to the work of Briquet (1859) ; it was the
first general work of real value and it prepared the way
for the contemporary studies. Lastly, you know that
the most eminent representative of that period is
Charcot, who in every way gave more precision to the
clinical knowledge of hysteria.
With these studies are connected the distinction be-
tween the epileptic and the hysterical fit, which was for
a long time considered impossible; the diagnosis of
apoplexies, cerebral lesions, meningites, of hysterical
mutisms, and fits of sleep; the separation between
hysterical anorexics, gastralgias, and dyspnaeas, and the
organic diseases which are apparently seated in the
same viscera. It is chiefly to the patient studies of our
predecessors that we owe the discovery and diagnosis
of the different motor accidents of hysteria, of the
articular disturbances analogous to the knee of Brodie,
of the contractures, of the paralyses limited to one
limb. Discussions relating to these motor accidents,
their comparison with the diverse organic paralyses, re-
searches on the traumatic neuroses, filled, as you know,
the career of Charcot.
In all these studies there was no room yet for an
interpretation of the disease, and Charcot felt thoroughly
the necessity of an interpretation of this kind. It was
indispensable, not only in order to explain things ap-
parently mysterious, but chiefly to give a unity capable
of linking together those innumerable symptoms that
The Problem of Hysteria 17
looked so heterogeneous. Lasegue had already said
that "manifestations apparently the most disorderly
have not the individual character one supposes, and
they are not inexplicable exceptions." " Nothing is left
to chance," said Charcot ; "on the contrary, all happens
according to rules, always the same, common to private
and hospital practice, applicable to all countries, to all
times, to all races." He naturally sought to discover
this determinism and these general laws of hysteria.
Carried along by his habits as a clinician, he has, I
think, sought these general laws too much in the physi-
ological domain, which led him to a certain number
of regrettable errors. In opposition to his school other
studies, and in particular those of M. Bernheim in
Nancy, have shown that this unity of hysteria, this in-
terpretation of the symptoms it presents, would be
much more surely found -in the domain of the moral
phenomena.
The contest of the two schools was the occasion of
the development of psychological pathology, of which
I have spoken to you, and brought on the beginning of
the third period, the psychological period of the studies
in hysteria.
This period, which has already lasted for about
twenty years, is still difficult to judge. It seems to me,
however, that its first clear results, though interesting,
are still very incomplete, and that I ought to warn
you against their attractive simplicity. A certain num-
ber of authors have been seduced by the psychological
explanation. It seemed to them that the mere words
"moral " and "thought" were enough to explain every-
1 8 The Major Symptoms of Hysteria
thing, and, as people generally like simple explana-
tions, physicians are too disposed nowadays to be con-
tent with a vaguely mental explanation. Hysteria, they
say, is a psychic disease ; it is the disease of suggestion,
taken in a vague sense; it consists in disturbances
which the patients persuade themselves that they have ;
it is the disease of persuasion. Many physicians think
that, when they have expressed a few formulas of this
kind, nothing remains to be said. There is some truth
in this view, for it brings into relief the psychic charac-
ter of the affection; but it is quite insufficient. We
should, in my opinion, retain something of the precise
method of Charcot, of the search after the determina-
tion and the laws of hysteria, and apply it only to the
psychological fact, instead of always seeking for this
determinism in physical facts. We must therefore use
a certain preciseness in the description and study of
the moral phenomena of hysteria.
The description of such a disease is very difficult, first
because the symptoms are exceedingly numerous. You
know that formerly Sydenham called it a Proteus, an
ever-changing malady. But the description is also
difficult because the disease is not clearly defined, be-
cause its limits, unfortunately, are very vague. It is
easy to see that many contemporary authors do not
quite agree about what they describe under the name
of hysteria, and that some have a much broader concep-
tion of the disease than others. This indecision generally
surprises young people. You think that, in science,
things are perfectly definite, and you are very much
astonished to find indecision in your masters. In
The Problem of Hysteria 19
reality definiteness does not exist in natural phenomena ;
it exists but in our systematic descriptions. It is the
men of science who cut separate pieces out of a whole
that nature has made continuous. Do you believe that
animal species are sharply distinguished from one an-
other? Look at the quarrels of naturalists about the
limits of the classes, about the animals of transition,
which may at will be connected with one class or an-
other. Remember the doctrine of evolution and the
origin of species of Darwin. All this is still truer in
regard to diseases, which, in reality, have not the dis-
tinctness we invent. Physicians, it is true, may agree
in certain cases, when there is a distinctly visible
objective phenomenon characterizing such or such a
lesion — histologic analysis will serve to define a syphilitic
lesion; in other cases, the presence of a microscopic
organism will be a guiding mark, and the recognition
of the bacillus of Koch will define a tuberculous lesion.
But unfortunately we have nothing of the kind at our
disposal to define the diseases of the mind. Save the
case of general paralysis, there is no anatomical means
to distinguish a patient labouring under the mania of
persecution from the one who is affected with melan-
cholia or neuropathy. When you have found the mi-
crobe of hysteria, you will be able to transform all my
descriptions and to make them much more accurate.
Nowadays there is evidently a hypothetic, conven-
tional part in the description and definition of a mental
disease. Nobody, I think, felt so clearly the necessity
of such hypotheses and conventions as Charcot when
he exposed what he called the method of types. When
2O The Major Symptoms of Hysteria
one wishes to describe a nervous disease, one must not
fancy that one may comprise in its description all
possible subjects. There are always some indistinct
phenomena, some aberrant cases, some contradictory
symptoms. In this case, if one tried to satisfy every-
body, one would satisfy nobody; by seeking to be too
true, one would be unintelligible. One must determine
on making a necessary hypothesis, which characterizes
the teaching and the opinion of a master; one must
choose among the innumerable cases of the disease that
which, in one's personal experience, appears to be the
most important, that which presents the most definite
phenomena, the most distinct from other maladies, the
most frequent with patients of the same kind, the most
intelligible. This patient becomes a type, which one
describes by preference, though one knows very well
that all the others are not absolutely like it, but because
one supposes that they deserve the same name in the
measure in which they resemble it.
This is what I shall try to do before you in describing
the major symptoms of hysteria. This word major in-
dicates well that I do not pretend to describe all possible
hystericals or all the shades these symptoms may
present, but that I only wish to show you what, in
my hypothesis, characterizes the typical symptoms of
hysteria. Such symptomatic and hypothetic descrip-
tions have the inconvenience of being transitory, of dis-
appearing very soon after us, but it would be a singular
illusion to seek to do something eternal. One has
already obtained a great result when one has done
something momentarily intelligible and useful. Charcot,
The Problem of Hysteria 11
whose method I cited to you, applied it in a rather
exaggerated degree in his description of hysteria; he
described a type of hysterical which disappeared with
him ; nobody nowadays any longer describes the attack
of hysteria as Charcot did. I think, however, that his
description did service to many a generation of students.
It brought about an enormous scientific movement,
which we continue by discussing it. No doubt, our
types of hysterical phenomena are ephemeral like his.
We wish they may have the same usefulness for some
time.
If I succeed in presenting to you a few simple types,
intelligible for you, of the mental state that is called
somnambulism, of the mental state that brings about
the functional paralyses and insensibilities, I shall, I
hope, have interested you in these studies of patho-
logical psychology, indispensable nowadays to the under-
standing of philosophical and moral problems ; I shall
have helped you a little to play later on your part as
physicians, for a physician should attend to the thought
of his patient ; I shall thus have accomplished, partially
at least, the wishes formed by your masters of Harvard
school when they did me the great honour to call me
among them.
LECTURE II
MONOIDEIC SOMNAMBULISMS
Somnambulism as the typical form of hysterical accidents —
Description 0} some cases of monoideic somnambulisms —
Their essential psychological characters — The emanci-
pation, the dissociation of an idea, of a partial system
of thoughts in somnambulism
THE several conceptions of an illness are characterized
by the choice of the symptoms described first and con-
sidered as the most important ones. During a long
time hysteria was considered as a chiefly physical dis-
ease, and consequently convulsions, in all appearance
deprived of intelligence, were put on the first line.
Hysteria was, above all, a convulsive illness whose
most important symptom was the fit. Charcot has still
continued that tradition, and you know the pains he
took to explain all that illness in taking as a starting-
point the convulsive attack. His theory is nowadays
considered very artificial, and his schematic conception
of the attacks tends to fall into oblivion; that lack of
success I easily explain through his error of the starting-
point. The hysterical fit of convulsions, far from being
a simple phenomenon, is, on the contrary, a very
variable and complex symptom. The convulsions have
all sorts of meaning ; sometimes they are in connection
with sensations or ideas and very complicated states
22
Monoideic Somnambulisms 23
of consciousness ; sometimes they are nearly deprived
of consciousness; in certain cases they are linked to
habits and grimaces, or depend upon moving agitation
in connection with certain voluntary paralyses. It
may be said that for some rather aged patients, whose
illness has lasted a long time, the convulsive attack
sums up all the hysterical accidents they have had since/
the beginning of the disease. The attack I consider as
a complex phenomenon that ought to be studied rather
at the end of a course of lectures than at the beginning.
To characterize at once the spirit of my teaching and
to make you understand how to construe that nervous
affection from the moral point of view, I ask you to put
in the first line, as the most typical, the most character-
istic symptom of hysteria, a moral symptom, — that is
somnambulism, — the fit of somnambulism which
appears spontaneously in hystericals. This is a new
medical conception which I consider an important one.
Somnambulism has been too long considered as a
rare phenomenon, impossible to explain, that adds itself
to the habitual troubles of neuropaths. To me som-
nambulism is, on the contrary, extremely frequent under
various forms, that may more or less conceal it. Som-
nambulism does not add itself to all sorts of neuropathic
troubles ; it constitutes the material point of a peculiar
neurosis, — hysteria. If one understands somnambulism
well, one is, I believe, capable of understanding all
hysterical phases that are more or less constructed on
the same model.
But among the various somnambulisms, a type must
be chosen to be first studied. Here we will not choose
24 The Major Symptoms of Hysteria
the form that occurs most frequently, but the necessity
of teaching will induce us to choose the simplest form
and the easiest to understand. This simple form of
somnambulism deserves to be called monoideic, and
that name will, I hope, be justified by this lecture.
Thus we have to examine together the typical forms
of monoideic somnambulism ; we shall then expose its
essentially psychological character, and we shall end
by trying to sum up in a simple and general conception
the character of these somnambulisms, in order to com-
pare gradually that first conception with those we shall
draw from the study of other hysterical phenomena.
What, then, exactly, is a somnambulist? Popular
observation has answered long ago : it is an individual
who thinks and acts while he is asleep. Without a
doubt that answer is not very clear, for we don't know
very well what sleep is. That answer means only that
the person spoken of thinks and acts in an odd way,
different from that of other people, and that at the same
time that person is in some way like a person asleep.
You will find nowhere a more beautiful description of
this popular conception of somnambulism than in
Shakespeare's tragedy, Macbeth: —
Doctor. I have two nights watched with you, but can perceive
no truth in your report. When was it she last walked?
Gentlewoman. Since his majesty went into the field, I have
seen her rise from her bed, throw her nightgown upon her,
unlock her closet, take forth paper, fold it, write upon 't, read it,
Monoideic Somnambulisms 25
afterwards seal it, and again return to bed; yet all this while in
a most fast sleep.
Doctor. A great perturbation in nature, to receive at once the
benefit of sleep and do the effects of watching ! In this slumbery
agitation, besides her walking and other actual performances,
what at any time have you heard her say?
Gentlewoman. That, sir, which I will not report after her.
Doctor. You may to me, and 't is most meet you should.
Gentlewoman. Neither to you nor any one, having no witness
to confirm my speech.
Enter LADY MACBETH, with a taper
Lo you, here she comes ! This is her very guise ; and, upon
my life, fast asleep ! Observe her ; stand close.
Doctor. How came she by that light?
Gentlewoman. Why, it stood by her; she has light by her
continually, 't is her command.
Doctor. You see, her eyes are open.
Gentlewoman. Ay, but their sense is shut.
Doctor. What is it she does now? Look, how she rubs her
hands.
Gentlewoman. It is an accustomed action with her, to seem
thus washing her hands; I have known her continue in this a
quarter of an hour.
Lady Macbeth. Yet here 's a spot.
Doctor. Hark ! she speaks ; I will set down what comes
from her, to satisfy my remembrance the more strongly.
Lady Macbeth. Out, damned spot ! out, I say ! — One, two ;
why, then 't is time to do 't. — Hell is murky ! — Fie, my lord,
fie ! a soldier, and afeard ? What need we fear who knows it,
when none can call our power to account ? — Yet who would
have thought the old man to have had so much blood in him?
Doctor. Do you mark that?
Lady Macbeth. The thane of Fife had a wife; where is she
now ? — What, will these hands ne'er be clean ? — No more o'
that, my lord, no more o' that; you mar all with this starting.
Doctor. Go to, go to; you have known what you should not
26 The Major Symptoms of Hysteria
Gentlewoman. She has spoke what she should not, I am sure
of that; heaven knows what she has known.
Lady Macbeth. Here 's the smell of the blood still; all the
perfumes of Arabia will not sweeten this little hand. Oh, oh, oh !
Doctor. What a sigh is there! The heart is sorely charged.
Gentlewoman. I would not have such a heart in my bosom
for the dignity of the whole body.
Doctor. Well, well, well, —
Gentlewoman. Pray God it be, sir.
Doctor. This disease is beyond my practice ; yet I have known
those which have walked in their sleep who have died holily in
their beds.
Lady Macbeth. Wash your hands, put on your nightgown;
look not so pale. — I tell you yet again, Banquo 's buried ; he
cannot come out on 's grave.
Doctor. Even so?
Lady Macbeth. To bed, to bed ! there 's knocking at the
gate; come, come, come, come, give me your hand. What 's
done cannot be undone. To bed, to bed, to bed ! [Exit.
Doctor. Will she go now to bed?
Gentlewoman. Directly.
Doctor. Foul whisperings are abroad. Unnatural deeds
Do breed unnatural troubles; infected minds
To their deaf pillows will discharge their secrets.
More needs she the divine than the physician. —
God, God forgive us all! — Look after her;
Remove from her the means of all annoyance,
And still keep eyes upon her. So, good night;
.My mind she has mated, and amaz'd my sight.
I think, but dare not speak.
Gentlewoman. Good night, good doctor.
[Exeunt.
Our modern examples are much less dramatic, but
they may be compared as to their most striking features.
Let me cite a certain number of cases to impress upon
Monoideic Somnambulisms 27
your mind the idea of this phenomenon, which to me
is a very important one. Here is a first instance: A
young woman, twenty-nine years old, called Gib.,
intelligent, sensitive, hears one day abruptly some dis-
astrous news. Her niece, who lives next door, has just
died in dreadful circumstances. She rushes out, and
comes, unhappily, in time to see the body of the young
girl lying in the street. She had thrown herself out
of the window in a fit of delirium. Gib., although very
much moved, remains to all appearance calm, helping
to make everything ready for the funeral. She goes
to the funeral in a very natural way. But from that
time she grows more and more gloomy, her health fails,
and we may notice the beginning of the singular symp-
toms we are going to speak of. Nearly every day, at
night and during the day, she enters into a strange
state; she looks as if she were in a dream, she speaks
softly with an absent person, she calls Pauline (the name
of her lately deceased niece), and tells her that she ad-
mires her fate, her courage, that her death has been a
beautiful one. She rises, goes to the windows and opens
them, then shuts them again, tries them one after an-
other, climbs on the window, and, if her friends did
not stop her, she would, without any doubt, throw
herself out of the window. She must be stopped,
looked after incessantly, till she shakes herself, rubs her
eyes, and resumes her ordinary business as if nothing
had happened.
A curious case I have lately observed is that of He.,
which I have related with more particulars in another
of my works. That woman, a hysterical thirty-five
28 The Major Symptoms of Hysteria
years old, was taking a walk in the zoological garden
during her menstrual period, when she was frightened
by a lioness that, as it was reported, seemed ready to
rush upon her. When she came back to the hospital,
she had a fit of delirium that lasted for eight days.
After some interruption, she again had fits of the same
odd delirium. In these crises she runs on all fours,
roars, rushes on people, trying to bite them; and al-
though she was anorexic before her attack and could eat
very little, now she pounces on all sorts of food, picks
it up with her teeth, and devours bits of paper and
small objects she finds on the floor. In a word, she
acts a comedy wherein she believes herself to be a lion-
ess. I say that she acts a comedy, for it becomes
certain that she studies her part, and that she often re-
places real actors by metaphors. For instance, she
looks in a drawer for photographs, generally children's
portraits, and tries to eat them up. Without any doubt,
as she is unable to devour real persons, she devours
them in effigy. I won't insist on the form here borrowed
by the idea rooted in her mind ; it is one of those changes
in personality brought about by a suggestion or an
invading idea which are already well known. At the
same time we may observe in He., when she is awake,
a very complete amnesia, that spreads not only upon the
delirium, but also upon the walk at the zoological garden.
Third observation: A man of thirty-two, Sm., pre-
sents a still more singular case. He usually remains
in bed, for both his legs are paralyzed. We won't
occupy ourselves with that paralysis to-day, although it
is a very odd one. In the middle of the night he rises
Monoideic Somnambulisms 29
slowly, jumps lightly out of bed, — for the paralysis we
have just spoken of has quite vanished, — takes his
pillow and hugs it. We know by his countenance
and by his words that he mistakes this pillow for his
child, and that he believes he is saving his child from
the hands of his mother-in-law. Then, bearing that
weight, he tries to slip out of the room, opens the door,
and runs out through the court-yard; climbing along
the gutter, he gets to the housetop, carrying his pillow
and running all about the buildings of the hospital with
marvellous agility. One must take great care to catch
him, and use all sorts of cautions to get him down,
for he wakes with a stupefied air, and as soon as he is
awake, both his legs are paralyzed again, and he must be
carried to his bed. He does not understand what you
are speaking about, and cannot comprehend how it hap-
pens that people were obliged to go to the top of the
house in order to look for a poor man who has been
paralyzed in his bed for months.
A fourth and last observation, for I insist upon relat-
ing to you a great number of instructive examples. We
come back to the common story of a young girl twenty
years old, called Irene, whom despair, caused by her
mother's death, has made ill. We must remember that
this woman's death has been very moving and dramatic.
The poor woman, who- had reached the last stage of
consumption, lived alone with her daughter in a poor
garret. Death came slowly, with suffocation, blood-
vomiting, and all its frightful procession of symptoms.
The girl struggled hopelessly against the impossible.
She watched her mother during sixty nights, working at
3<D The Major Symptoms of Hysteria
her sewing-machine to earn a few pennies necessary to
sustain their lives. After the mother's death she tried
to revive the corpse, to call the breath back again ; then,
as she put the limbs upright, the body fell to the floor,
and it took infinite exertion to lift it again into the bed.
You may picture to yourself all that frightful scene.
Some1 time after the funeral, curious and impressive
symptoms began. It was one of the most splendid
cases of somnambulism I ever saw.
The crises last for hours, and they show a splendid
dramatic performance, for no actress could rehearse
those lugubrious scenes with such perfection. The
young girl has the singular habit of acting again all the
events that took place at her mother's death, without
forgetting the least detail. Sometimes she only speaks,
relating all that happened with great volubility, put-
ting questions and answers in turn, or asking questions
only, and seeming to listen for the answer; sometimes
she only sees the sight, looking with frightened face
and staring on the various scenes, and acting according
to what she sees. At other times, she combines all
hallucinations, words, and acts, and seems to play a very
singular drama. When, in her drama, death has taken
place, she carries on the same idea, and makes every-
thing ready for her own suicide. She discusses it
aloud, seems to speak with her mother, to receive ad-
vice from her ; she fancies she will try to be run over by
a locomotive. That detail is also a recollection of a
real event of her life. She fancies she is on the way, and
stretches herself out on the floor of the room, waiting
for death, with mingled dread and impatience. She
Monoideic Somnambulisms 31
poses, and wears on her face expressions really worthy
of admiration, which remain fixed during several
minutes. The train arrives before her staring eyes,
she utters a terrible shriek, and falls back motionless,
as if she were dead. She soon gets up and begins acting
over again one of the preceding scenes. In fact, one
of the characteristics of these somnambulisms is that
they repeat themselves indefinitely. Not only the dif-
ferent attacks are always exactly alike, repeating the
same movements, expressions, and words, but in the
course of the same attack, when it has lasted a certain
time, the same scene may be repeated again exactly
in the same way five or ten times. At last, the agita-
tion seems to wear out, the dream grows less clear, and,
gradually or suddenly, according to the cases, the patient
comes back to her normal consciousness, takes up
her ordinary business, quite undisturbed by what has
happened.
I could tell you many more of these examples, for all
the events of life may be reflected in one of these scenes.
This patient acts over again a scene wherein he has been
bitten by a dog ; that one reproduces in his dream the
emotion he had when he was wounded by the falling
of the lift. This little girl fancies a scene of her school
life, in which she was severely punished; that young
girl reflects a scene of ravishment ; a young boy repeats
a quarrel in the street ; another man lives through a
chapter he has read in a novel, where thieves get through
a latticed window and bind him tightly to his bed. This
kind of delirium may vary over and over again in a
thousand different ways. It is, however, very character-
32 The Major Symptoms of Hysteria
istic, and in all mental pathology you will not find
another delirium that may be compared with it. It is
then necessary to study carefully the psychological
character of which it is made up ; for the precise analy-
sis of this simple delirium will perhaps be the starting-
point whence we shall proceed to explain the other
more complicated states.
II
Innumerable studies have been written to analyse
the preceding state in every particular. I shall only
sum up the very clear result of those studies, and I
shall do it by following that state from its starting-point
to the return of normal life. There is a first very im-
portant period, but on it we cannot yet dwell; it is
the moment when somnambulism begins, the change
from the normal to the second state. When the change
is sudden, there is, as it seems, a loss of consciousness,
a half faint. When the change is slow, one may
easily observe the abasement of mental activity; the
patient pays no more attention to exterior events ; he
understands less and less what you tell him, and he an-
swers with difficulty, is absent-minded, works more
slowly, or interrupts his work. In short, voluntary
activity and close application seem to disappear, to give
place to the expansion of the dream.
When the dream begins, you may note a very strik-
ing and important characteristic ; namely, the perfection
and the intensity of its development. All the phenom-
ena in connection with the dream seem enormously
Monoideic Somnambulisms 33
increased. Undoubtedly we all take expressions and
attitudes in connection with our thought, but our ex-
pressions look shabby and incomplete in comparison
with the marvels of plasticity we may sometimes ob-
serve in somnambulism. Some of the patients, as
we have already remarked, neither speak nor move,
but remain fixed in an expressive attitude. That form
of monoideic somnambulism is called catalepsy. We
have no time to dwell on all its various forms ; we will
only point out the perfect expression of those living
statues that have often inspired superstitious wonder.
We may learn by different means what images fill
his consciousness, and we may see that he has not our
dull memory df things, but that he sees the objects he
speaks of, and really hears, feels, touches them exactly
as if they were real. The unfolding of hallucinations is
incomparable, and except in some crises of alcoholic
delirium, that are a little like hysteria, we shall never
find in lunacy such abundance and such copiousness
in the hallucinations of all senses. When the patient
speaks, he has a fluency of elocution and even an elo-
quence that seems superior to his normal powers,
because he gives himself entirely up to the idea he means
to express. When he acts, he has a precision and quick-
ness in his movements that make a wonderful actor of
him, and here, again, he surpasses his usual powers.
The patient we just spoke of, the one who believed he
was rescuing his child by carrying his pillow, ran on the
housetop with more agility than he would have shown
in his normal state, even if he had not been palsy-
stricken. One of my patients who does not know how
34 The Major Symptoms of Hysteria
to write, writes during her somnambulism. It is no
wonder, and there is no mystery about the case ; in the
somnambulic state that woman remembered the writ-
ing she had learned at school, as a child, and had to all
appearance forgotten thirty years ago.
The development of the somnambulic delirium is not
only intense, it is also perfectly regular. The patient
repeats the same words at the same moments, makes
the same gestures at the same place, every time he be-
gins his performance over again. He seems to have on
that point a marvellous memory; when he has appro-
priated his somnambulism to a given room, he remem-
bers all that he did at each different spot ; he knows
from what drawer he took the photos he pretends to
eat up, in what table he found a bit of wood that he
used as a pistol; he goes directly to that spot, unhesi-
tating, knowing exactly what he expects to find there.
Sometimes, in the course of various somnambulisms,
the patient, instead of beginning his history over again,
takes up his delirium at the exact point where he last
stopped, and seems to remember perfectly at what
point he broke off in his last delirium. You recollect
one of Charcot's somnambulists who believed himself
a journalist and who wrote a novel; he waked after
writing two or three pages, which were taken away from
him. In the next crisis, he began his novel exactly at
the point where he had broken off. You see what an
important part regularity and memory play in these
scenes. Inversely, the patient's liberty or power of
will seem to have no share in these crises, for the scene
is never altered in the way the patient could wish.
Monoideic Somnambulisms 35
This negative character will become even more striking
if we study somnambulism from another point of view.
In contrast with the brilliant unfolding of some
phenomena, we discover with amazement strange
mental blanks. The same patient who looks as if he
had very precise sensations, since he can walk on the
house's top, look for objects in a drawer, and see very
clearly the bed where, in his fancy, his mother lies dying,
— this same patient seems unable to grasp anything else.
This is what first struck popular observation. Speak
to them and they do not answer; try by all sorts of
means to make your presence felt, they do not seem to
feel it. The objects you thrust before their eyes do not
in the least alter their dream, and do not in the least
stop it ; as the doctor remarks in the case of Lady Mac-
beth, their eyes seem open, but they are shut to all im-
pressions that are not connected with their dream.
To make yourself heard, you must dream with the
patient and speak to him only words in accordance with
his delirium.
As the patient perceives nothing except the idea he
is possessed of, he remembers nothing except that one
idea. He knows not where he is ; he has quite forgotten
the changes that have taken place since the time he
speaks of; he often does not even know his name.
His memory, as well^as his sensations, is shut up hi a
narrow circle.
The somnambulism is ended ; the patient comes back
to consciousness. We may then notice new characteris-
tics and see how they add themselves to the preceding
ones. The patient resumes his former sensations; the
36 The Major Symptoms of Hysteria
memory he has lost comes back, he knows his name,
knows also where he is, and remembers all the events of
his life ; he has, to all appearance, his former character
and personality; but the wonderful thing is, that, in
this new personality, somnambulism has left a gap.
He appears to have forgotten all that preceding period
that amazed us to such a point by its dramatic character.
He is not disturbed by it; he does not endeavour to
apologize for the ridiculous acts he has just accomplished ;
he wonders sometimes at the untidiness of the room,
of which he is himself the cause, and cannot understand
how it came about. If you question him, try to awaken
his memory by direct questions, either of two things may
happen. In describing with too much accuracy what
the patient has just done in his delirium, you will either
revive his memory so vividly that he will fall back again
into the preceding state, be wholly taken up by that
recollection, forget that you are there and act the whole
scene over again ; or, as more frequently happens, you
will be unable to recall to his mind the lost memory.
He does not understand what you mean. All the pre-
ceding scene which hi reality is so lively and persistent
in his memory, since it will begin over again, or will
enter in the next crisis, seems at that moment quite out
of his consciousness. These are the chief psychological
characteristics that come out in somnambulism. Dur-
ing the crisis itself, two opposite characteristics manifest
themselves; first, a huge unfolding of all the phe-
nomena connected with a certain delirium ; second, an
absence of every sensation and every memory that is not
connected with that delirium. After the crisis, during
Monoideic Somnambulisms 37
the state that appears as normal, two other character-
istics appear, opposite, to all appearance : the return of
consciousness of sensations and normal memory, and
the entire forgetfulness of all that is connected with the
somnambulism. Let us remember all these notions
that here seem very simple, and we shall afterwards see
them unfolded in every hysterical phenomenon.
Ill
The facts and the laws of somnambulism we have
just described have been well known for a longtime, and
usually they made up all that was studied about this
curious state. But I believe that we must notice an-
other interesting fact in order to understand better the
whole of the monoideic somnambulism. This fact is
usually more or less concealed, but it becomes very
apparent and conspicuous in certain cases.
Let us take up the case of that young girl, Irene,1
who acts during her somnambulism the scene of her
mother's death with such apparent precision. Let
us watch her during the intervals of her fits, during the
period in which she seems to be normal ; we shall soon
notice that even at that time she is different from what
she was before. Her relatives, when she was conveyed
to the hospital, said to us : "She has grown callous and
insensible, she has soon forgotten her mother's death,
and does not seem to remember her illness." That
remark seems amazing; it is, however, true that this
1 Cf. "L'amn^sie et la dissociation des souvenirs par l'£motion,"
Journal de psychologic normale et pathologique, 1904, p. 417.
38 The Major Symptoms of Hysteria
young girl is unable to tell us what brought about her
illness, for the good reason that she has quite forgotten
the dramatic event that happened three months ago.
"I know very well my mother must be dead," she says,
" since I have been told so several times, since I see her
no more, and since I am in mourning ; but I really feel
astonished at it. When did she die? What did she
die from ? Was I not by her to take care of her ? There
is something I do not understand. Why, loving her as I
did, do I not feel more sorrow for her death ? I can't
grieve ; I feel as if her absence was nothing to me, as if
she were travelling, and would soon come back." The
same thing happens if you put to her questions about
any of the events that happened during those three
months before her mother's death. If you ask her
about the illness, the mishaps, the nightly staying up,
anxieties about money, the quarrels with her drunken
father, — all these things have quite vanished from her
mind. If we had had time to dwell upon that case, we
should have seen these many curious instances : the
filial love, the feeling of affection she had felt for her
mother, have quite vanished. It looks as if there was a
gap as well in the feelings as in the memory. But I
shall insist only on one point : the loss of memory
bears not only, as is generally believed, on the period of
somnambulism, on the scene of delirium; the loss of
memory bears also on the event that has given birth
to that delirium, on all the facts that are connected with
it, on the feelings that are related to it.
This very important remark may be extended to all
the other cases I have related. He., who has the de-
Monoideic Somnambulisms 39
lirium in which she fancies herself a lioness, has not
only forgotten this period of somnambulism, but also the
walk in the zoological garden, that first cause of her
delirium. Sm., who carries his pillow on the house-
top, believing that he is rescuing his child from the
clutches of his mother-in-law, does not remember his
quarrels with that woman, although those quarrels were
the starting-point of the actual disease.
I have noted down in this connection a very singular
observation, in which this retrograde amnesia accom-
panying somnambulism is well brought into evidence.1 A
young girl, nineteen years old, Lie., has fits of somnam-
bulism in which she speaks about thieves, about a fire,
and calls to her help a certain Lucien. When awakened,
she knows nothing about all this, and when you speak to
her of what she said, she pretends that in her life there
is no event in which any part was played by thieves,
by a fire, or by Lucien. As she had come alone to the
hospital, we had no other information, and were com-
pelled to believe that she had an imaginary delirium.
Six months afterwards only, some relatives of hers,
who had come from the country to see her, told us of
an event that happened three years before, and was the
starting-point of her nervous crises. She was a servant
in a country seat which one night was robbed and set
on fire by thieves, and she was rescued by a gardener
called Lucien. It is astonishing that this young girl
could have utterly forgotten such an important event,
and that she was never able to speak about it when she
1 Cf . " N^vroses et Idees fixes," 1898, Vol. II, observation 69,
p. 234.
40 The Major Symptoms of Hysteria
related to the physician the story of her life and the be-
ginning of the disease. It is worthy of note that the
forgetfulness of this fact coincides with the development
of that extraordinary memory on the same subject that
filled her somnambulism.
Without any doubt the forgetfulness of the idea which
plays the greatest part in the monoideic somnambulism
is not always so clear, so perfect. But I believe this
forgetfulness always exists more or less concealed, and
the profundity of the forgetfulness is in proportion to the
depth, the serious nature of the somnambulism itself.
According to my belief, the somnambulism is followed
by an amnesia which is retrograde, and bears not only
on the somnambulism itself, but also on all the facts,
the memories related to it. I beg the observers who
can study such cases of somnambulism to notice with
great, care these troubles of memory added to the
disease.
How can we understand, how can we picture to our-
selves the whole of these facts? What is the essential
point which can sum up the observations? I propose
to you the following psychological interpretation. An
idea, the memory of an event, for instance, the thought
of a ferocious animal, the thought of a mother's death,
— all these form groups of psychological facts closely
connected with one another; they are certain kinds of
systems comprising all sorts of pictures and all sorts
of tendencies to certain movements, but with a strong
unity. These systems in our minds have" their strength
and their law of development that are peculiar to them.
They have also a great tendency to development
Monoideic Somnambulisms 41
when they are not kept within bounds by another
power.1
Allow me to represent to you this system of psycho-
logical facts, which constitutes an idea, by a system of
points connected together by some lines, forming a sort
FIG. i.
of polygon (Fig. i). The point S represents the sight
of the face of the dead mother, the point V is the sound
of her voice; another point, M, is the feeling of the
movements made to carry up the body, and so on.
This polygon is like the system of thoughts which was
1 See these laws of development of the mental systems in my first
book, " L'automatisme psychologique," 1889.
42 The Major Symptoms of Hysteria
developed in the mind and in the brain of our patient
Irene. Each point is connected with the others, so
one cannot excite the first without giving birth to the
second, and the entire system has a tendency to develop
itself to the utmost.
But at the same time in healthy minds these systems
pertaining to each idea are connected with an infinitely
wider system of which they are only a part, — the system
of our entire consciousness, of our entire individuality.
The remembrance of the mother's death, even the
affection Irene feels for her mother, with all the memo-
ries that are connected with it, forms only a part of the
whole consciousness of the young girl with all its memo-
ries and other tendencies. Let this large circle, P, near
the little polygon represent the whole personality of the
girl, the memory of all that happened in her previous
life.
Normally, in good health, the little system must be
connected with the large one, and must in great part
depend on it. Generally the partial system remains
subject to the laws of the total system : it is called up
only when the whole consciousness is willing, and within
the limits in which this consciousness allows it.
Now, to picture to ourselves what has taken place
during somnambulism, we may adopt a simple provi-
sional resume. Things happen as if an idea, a partial
system of thoughts, emancipated itself, became inde-
pendent and developed itself on its own account. The
result is, on one hand, that it develops far too much,
and, on the other hand, that consciousness appears no
longer to control it. That general remark may still
Monoideic Somnambulisms 43
seem to you very vague and very difficult to understand.
Nevertheless, I wished to point it out to you in a few
words : first, because it emerges very clearly out of the
study of the first phenomenon of hysteria ; secondly,
because it will serve us as a clew to understand a thou-
sand other cases of the neurosis. Don't trouble about
the obscurity of that first remark; after you have
repeated it exactly in the same way with regard to a
thousand different phenomena, it will not be long before
you find yourself understanding it clearly.
LECTURE III
FUGUES AND POLYIDEIC SOMNAMBULISMS
Transformations and exaggerations of the first somnambu-
lisms— Several cases of fugues — The laws of fugues —
The diagnosis of hysterical fugues — Differences between
fugues and monoideic somnambulisms — The characters of
polyideic somnambulisms and their relations to the simpler
forms — The emancipation of feelings and emotions
A GREAT many hysteric accidents are directly con-
nected with the kind of somnambulism we have just
studied. They are only slight transformations of the
same phenomenon. Sometimes somnambulism in-
creases, develops in a particular direction, sometimes
it diminishes, keeps back only a few symptoms, and
it is sometimes difficult to know it again. But the
phenomena are still of the same kind ; they must be ex-
plained in the same manner, and, if we wish to under-
stand hysteria well, it is very important we should know
the possible transformations of that fundamental state
of somnambulism. To-day, and in our next lecture, we
shall study the exaggerations and developments that
multiply to a very high degree our first monoideic som-
nambulism. The first fact we meet with, in this di-
rection, is one of the most wonderful phenomena of
hysteria, the study of which has already attracted many
authors. This fact is the hysterical mania of running
44
Fugues and Polyideic Somnambulisms 45
away that we call ambulatory automatism, flights, or
better, fugues, if we may keep the French word.
We shall begin, as we are wont to, by showing you a
certain number of clinical cases, as if the patients were
here before your eyes. We shall thus more easily
acquire the knowledge of the clinical characters and of
the general idea that is to be derived from them.
Here is a splendid case of hysterical fugue, remarkable
for its simplicity. You can find the entire description
of it in the Gazette des Hopitaux, where I published it
with Professor Raymond on the second of July, 1895.
The subject is a man, P., thirty years old, employed hi
a railway station in a town in the east of France.
Although an active and clever fellow, he was a little
eccentric, and had already led a somewhat adventurous
life. In his youth he had had frequent fits of somnam-
bulism, sometimes in the day, but mostly at night.
Moreover, the tendency to somnambulisms is to be
found in his family, since his brother was also a noctur-
nal somnambulist, who got out of his bed while asleep
to work at his exercises. One day, like a patient we
have spoken of, he carried his pillow on the housetop,
mistaking it for a little baby. If I dwell upon these pre-
vious somnambulisms similar to those we have already
described, it is because they form a link between the
first phenomena we have spoken of and those we shall
describe to-day. This man, P., was also very easily
affected, predisposed to fixed ideas. One day, in the
46 The Major Symptoms of Hysteria
notary's office where he worked, he was slightly suspected,
though not accused, of stealing a trifle. He fell ill, and
was very distressed. Night and day he discussed that
suspicion, and, although everybody tried to prove to
him how trifling it was, he could not remain in that
office. Moreover, he had a tendency to exaggerated
fears. He had left Lorraine after its annexation to
Germany, and during many years he was haunted by
the fear of the German police, whom he always believed
to be running after him. All those details have their
importance: you must not forget thus to inquire into
the previous character of your patients; such an in-
quiry will often enable you to understand very well the
neuropathic diseases that come on later. However
that may be, the man we are talking of had also an ad-
venturous turn of mind. He started with the Crevaux
mission on an expedition to South Africa, and was sent
back to France on account of his health. Then he
enlisted under the orders of De Brazza, who was starting
for Gabon. There, we must also notice, he was very
much debilitated by diseases peculiar to hot climates,
and continued long after his return to have fits of the
ague. This also is serious enough to prepare the way
for the ensuing mental weakness.
On his return to France, at the age of twenty, he got
a situation in a railway company, and was soon in easy
circumstances. He married, and had a child he dearly
loved. His wife was again pregnant when the following
incident took place. Although he led a quiet and
rather happy life, he was uneasy in his mind, and gave
himself up to intellectual labours too hard for a man
Fugues and Polyideic Somnambulisms 47
who had no great acquirements. To his work in the
railway office he added bookkeeping and, what is more,
he drew up a geographical account of Gabon from the
notes he had taken, and this work gave him much
trouble. He was made uneasy in his mind by family
quarrels : his brother, who was jealous of him, had just
quarrelled with him and had charged him with shameful
and dishonest acts. The charge was groundless, and
nobody around him troubled about it, but we know how
easily upset, how susceptible he was in that quarter, and
how he lost his head at the mere idea of a charge of
that kind.
It is in these conditions that we come to the third of
February, 1895. He was alone at Nancy, his wife
having left him for a few days. He had just ended a
chapter of his work on Gabon, and, to take a little rest,
he went to a coffee-house where he was well known.
During the afternoon, a part of which he spent with
some friends at this coffee-house in playing billiards,
he drank a cup of coffee, two glasses of beer, and a
small glass of vermouth which the coffee-house keeper
wished him to taste. He told us himself all these cir-
cumstances, which he remembers quite well. He also
knows that one of his neighbours came to the coffee-
house and invited him to dinner, as he was alone at
home. He accepted the invitation. So everything was
as it should be, and he has a very exact memory of all
that happened then. He left that coffee-house about
five, ready to go and dine with his friend; but a few
yards off, while crossing the Stanislas bridge over the
railway line, just as he got to the middle (that also he
48 The Major Symptoms of Hysteria
perfectly remembers), he felt a violent pain in his head,
as if he had been struck on the posterior part of his head.
I point out these sensations to you without being able
to dwell on them, for they have not as yet been suffi-
ciently accounted for. But it is necessary you should
know they often occur in the same conditions with
neuropathic patients. The blow in the occiput is very
often characteristic of great fits, of great changes of
personality. It is just what happened in this case,
for immediately after that something must have
changed in the mental state of our patient, as he has
entirely lost the memory of all that happened after-
wards on that Sunday, the third of February, 1895,
and on the following days.
When he comes back to consciousness, or rather
when he resumes the thread of his recollections, the
circumstances are changed to an extravagant degree.
His first recollection is the following : he was lying in a
field, covered with snow, half dead, and amazed to find
himself in that place ; he got up painfully, found a road
with a tramway line, walked along that line, and finally
got, not without difficulty, to a town quite unknown
to him, near a railway station. It was the South Station
at Brussels. It was eleven o'clock in the evening, and
the date he read in a newspaper was the twelfth of
February. In short, he had felt a shock on the head
at Nancy on the third of February, and awoke in the
neighbourhood of Brussels on the twelfth. All that had
happened in the meantime, how he accomplished that
singular journey, he does not in the least know.
He telegraphed to ask for assistance: he was taken
Fugues and Polyideic Somnambulisms 49
care of and conveyed to Paris to the Salpe'triere, where
we studied his case. I will not now explain to you how
we revived his recollections ; it would imply notions on
hysteria that you have not yet acquired. I shall only
tell you that we contrived to know what happened during
those nine days, and that we may now add it to the story
of his fugue.
On the Stanislas bridge, after he had felt the blow on
the head, he felt himself overwhelmed with fear at the
thought of the charge brought against him by his
brother, so that he went home in great anxiety. A few
slight occurrences, too long to tell, increased the feeling
of guilt, and in the evening, which he spent in wandering
about the streets without going to his neighbour's for
dinner, he constantly pondered on the way to escape
those accusations and on the means of running away.
He returned home, where he took some money, and went
to sleep in an hotel in the suburbs instead of remaining
quietly at home. He rose early, and avoiding the rail-
way, went on foot through the fields to Champigneul.
When he had arrived there he went to the railway
station, where he was not known, and took a ticket for
Pagny on the Moselle; from Pagny he walked to
Longwy, still avoiding with the greatest care the per-
sons who, he fancied, were running after him. And in
fact he did avoid them very well, for his disappearance
had been noticed, and he was sought after with great
anxiety. At Longwy he took the train to Luxemburg,
then to Arlon and to Brussels, still* with the rooted idea
of taking refuge in a foreign country under a false name,
in order to escape pursuit. At Brussels, he first went
50 The Major Symptoms of Hysteria
to a good hotel and spent his days in seeking the means
of earning a few pence. But he did not succeed, and
his small means dwindled away. He took lodgings in
a very shabby room, then in one of those asylums where
poor people are lodged at night. There a good man had
pity on him and gave him a letter of introduction to a
charitable foundation. That letter played afterwards
an important part, for he found it again in his pocket
after waking up, and it enabled him, at the time of his
recovery, to retrace the former events and to recollect
what had happened. But on the day it was given to
him he did not use it, so that he fell into the most
terrible poverty. He was on the point of enlisting for
the Dutch Indies ; but, happily, he was not accepted.
Fancy that unhappy man in the midst of a crisis of
somnambulism sailing for India. Exhausted with
fatigue and want of food, he stretched himself on the
snow in the fields with the vague idea that he was about
to die.
Here something very extraordinary happened, some-
thing very interesting as a psychological fact. As he
thought he was at the point of death, he could not help
changing the bent of his thoughts, and in spite of him-
self, he thought that he would like to see his family
before he died, stretched out in the snow. You must
notice that the thought of his family had never entered
his mind during the last days. The appearance of this
idea had an unexpected result. He immediately said
to himself, "But, after all, why am I dying here, far
from my family?" He got up; he was awake: you
know what happened afterwards. I want only to point
Fugues and Polyideic Somnambulisms 51
out to you that enormous change in the mental state
brought about by an idea.
The fact is so interesting, that we must observe it a
second time in another case I have studied; it is also
a very strange one. I will only sum up the more
important facts. If you care to read this entertaining
observation, you will find it at full length in the second
volume of my work on neuroses and fixed ideas.1 Here
I shall only state the facts that are interesting for us
to-day.
The subject is a boy of seventeen, Rou., son of a
neuropathic mother, rather nervous himself, who already
had, when he was ten years old, tics and contractures
in the neck, of which we shall speak in one of our fol-
lowing lectures. At thirteen he often went to a small
public house, visited by old sailors. They would urge
him to drink, and, when he was somewhat flustered,
they would fill his imagination with beautiful tales in
which deserts, palm trees, lions, camels, and negroes
were pictured in a most wonderful and alluring way.
The young boy was very much struck by those pictures,
particularly as he was half tipsy. However, when his
drunkenness was over, the stories seemed to be quite
forgotten ; he never spoke of travels, and, on the con-
trary, led a very sedentary life, for he had chosen the
placid occupation of a grocer's boy, and he only sought
to rise in that honourable career.
Now there come on quite unforeseen accidents,
almost always on the occasion of some fatigue or a fit
of drunkenness. He then felt transformed, forgot to
1 " Necroses et Idees fixes," II, p. 256.
52 The Major Symptoms of Hysteria
return home, and thought no more of his family. He
would leave Paris, walking straight ahead, and go to a
more or less great distance through the forest of St.
Germain, or as far as the department of the Orne.
Sometimes he walked alone ; at other times he rambled
with some tramps, begging along the roads ; he had but
one idea left in his head ; namely, to get to the sea, enlist
in a ship and sail away towards those enchanting coun-
tries of Africa. His journeys ended rather badly; he
would awake suddenly, drenched, half starving, either
on the highroad or in an asylum, without ever being
able to understand what had happened, without any
memory of his journey, and with the most ardent wish
to go back to his family and his grocery.
I will dwell on only one of his fugues, which is par-
ticularly amusing, and was of extraordinary duration, for
it lasted three months. He had left Paris about the
fifteenth of May, and had walked to the neighbourhood
of Melun. This time he was thinking about the means
of succeeding in his scheme and of getting safely to the
Mediterranean. Until then he had failed, owing to
fatigue and misery : the question was to find means of
living as he went along. A bright idea had occurred
to him ; not far from Melun, at Moret, there are canals
that go more or less straight to the south of France, and
in those canals there are ships laden with goods. He
succeeded in being accepted as a servant on a ship
laden with coal. His work was terrible ; now he had to
shovel the coal, now to haul the rope in company with
a donkey called Cadet, his only friend. He was badly
fed, often beaten, exhausted with fatigue, but, though
Fugues and Polyideic Somnambulisms 53
you would scarcely believe it, he was radiant with hap-
piness. He thought only of one thing, — of the joy of
drawing nearer to the sea. Unhappily, in Auvergne,
the boat stopped, and he was forced to leave it and
continue his journey on foot, which was more difficult.
In order not to be resourceless, he hired himself as a
helper to an old china mender. They went slowly
along, working on the road.
Then, one evening, an unlooked-for event took
place again. The day's' work had been a success;
the two companions had earned seven francs. The
old china mender stopped and said to R., "My boy,
we deserve a good supper; and we will keep to-day's
feast; it is the fifteenth of August." On hearing
this, the boy heedlessly said: "The fifteenth of
August ? Why, it is the feast of the Virgin Mary,
the anniversary of my mother's name-day." He
had scarcely uttered these words when he appeared to
be quite changed. He looked all around him with
astonishment, and turning to his companion, said,
"But who are you, and what am I doing here with you ? "
The poor man was amazed, and was quite unable to
make the boy understand the situation; the latter
still believed himself in Paris, and had lost all memory
of the preceding months. They had to go to the
village mayor's, where, with great difficulty, the matter
was made more or less clear. The mayor telegraphed
to Paris, and the prodigal child was sent back home.
Is not that name, which suddenly evoked the memory
of his mother and awakened him likewise, a pretty
conclusion of a fugue ?
54 The Major Symptoms of Hysteria
The same particular is to be found in this final
observation, which I will relate in a few words. A
young man of twenty-nine, a clerk at a notary's office,
had made a fugue of the same kind as the preced-
ing ones, and impelled by a fixed idea, had gone as
far as Algeria. He found himself at Oran, sitting on the
terrace of a coffee-house, quietly reading his newspaper,
when his eyes fell on a singular piece of news. The
newspaper related the story of the sudden disappearance .
of a young notary's clerk, aged twenty-nine, of such a
name, and wondered what had become of him. " Why,"
thought the young man; quite amazed, "I am that
young man ; what can have happened ? " And he awoke
without remembering his freak in the least. You see
that the three observations are very much alike. It was
formerly thought that such cases were very rare, and
that they each had particular characters. In reality
it is not so, and we could easily collect twenty very
typical instances quite similar to the three we have just
described, and in which you would easily recognize
the same features.
n
Let us then try and find the characteristic feature of
the observations we know. You have noticed your-
selves, while listening to me, how obvious the analogy
is between the phenomena called hysterical fugues and
the monoideic somnambulisms we lately studied. In a
general way, the essential characters are the same, and
we could without difficulty apply to the former the
Fugues and Polyideic Somnambulisms 55
four laws we applied to the latter. First, during the
abnormal state there is a certain idea, a certain system
of thoughts that develops to an exaggerated degree. It
is evident that P., for instance, constantly thinks, during
the eight days his fugue lasts, of the charge brought
against him by his brother, of the consequences it may
have for him, and of the means of eluding capture. It is
obvious that the young R. ponders during three months
over the means of getting to the Mediterranean and
the hope of finding a ship there and sailing for Africa.
Such thoughts are disproportionate to the situation of
a railway officer, the father of a family, and to that of a
grocer's boy. They bring about certain acts, they add
to the endurance of those people who travel on foot,
work, and bear hardships without difficulty.
The second law applies equally well. During the
abnormal state, the other thoughts, relating to the for-
mer life, the family, the social position, the personality,
appear to be suppressed. It is very likely that during
their fugues those people assume false names, and
create for themelves fictitious personalities; you will
find with regard to this last detail an interesting obser-
vation in the paper of Mr. H. Coriat of Boston, published
in the third number of The Journal of Abnormal Psy-
chology, 1906, p. 109. The important point is that these
people have lost the memory of their real personality.
This seems strongly confirmed by the phenomenon
of the awakening. When some chance occurrence
brings back to their mind a thought about their family,
their real name, their former self, they fall into another
system of ideas and wake up. This proves conclusively
56 The Major Symptoms of Hysteria
that, during the abnormal state, chance had not roused
that category of recollections.
Outside of the time of the fit or of the abnormal
state, and during the period considered as normal
(you already guess it is not entirely so), the two inverse
laws apply. The recollections of the fugue have van-
ished, and that to an extraordinary extent. But, at
the same time, the thoughts and feelings connected
with an idea that predominated during the fugue have
disappeared more or less completely. I have already
pointed out to you that young R. was a model grocer's
boy, taking much interest in the sugar and coffee trade,
dreaming only of the pleasure of going on Sundays
with his mother to the Saint- Cloud fair, and having
none of the tastes of an adventurous sailor. He does
not continually feel this longing for travels, and even
grieves very much when you speak to him about
-his fugues. He is afraid they may begin again, since he
comes of himself .to the hospital in order to get advice
and be rid of them. I insist on that point. If the boy
really had, all the time, a taste for travels beyond the
seas, a taste which after all he might have, he would
not feel troubled about his fugues; he would resign
himself, in the idea that, if they were successful, they
might prove profitable to him. But he is far from
doing so, for, during his normal life, his feelings are not
the same as during the period of his fugue. You may
observe the same fact in the railway clerk, P. Wtyen
he is awake, he does not speak at all in the same way
of the charge his brother brought against him ; not only
does he realize perfectly that there is no truth in it,
Fugues and Polyideic Somnambulisms 57
but he also feels that it is of no importance. He
feels it is not worth while to upset his home and spoil
his situation. There is obviously something in this that
recalls the amnesia of her mother's death we have
noticed in Irene and the disappearance of her feelings
of filial love.
Lastly, during the state considered as normal you find
the development of the psychological phenomena that
were suppressed during the period of the crisis: rec-
ollection of the entire existence, perception of all
present occurrences, exact notion of personality. In
short, you see that the four characteristic laws of som-
nambulisms apply to such cases. If to this you add
that these fugues present themselves in individuals
who have already had, as I told you in the case of P.,
fits of somnambulism; or if you remark that such
individuals are apt to present somnambulic states later
on, as happened with Rou., it seems still more justi-
fiable to bring the two phenomena together and say
that, upon the whole, fugues are kinds of hysteric som-
nambulisms.
We must insist a little while upon this summary
and this diagnosis. In my opinion, these fugues must
be ranked among hysterical somnambulisms for two
reasons : first, because they represent to us all the major
characteristics already known of hysterical somnam-
bulism. In the next lecture you will learn a new char-
acteristic of this somnambulism : that it may be arti-
ficially reproduced, and that in this artificially induced
somnambulism the memory of the first abnormal stage,
of the fit of natural somnambulism, reappears entirely.
58 The Major Symptorlis of Hysteria
This new characteristic, which we shall study a little
later, and which I simply allude to, can be still found
exactly in the fugues we are now examining. Long
after the awakening of his last fugue, when he seems
to have no remembrance at all of what happened,
the young Rou. can be put into artificial somnambu-
lism and can then relate to us with amusing precise-
ness all his adventures in the ship laden with coal,
and his friendship with the donkey, Cadet, hauling
the rope with him. When all these characteristics, and
especially the last one, are to be found in a fugue, it
seems to me difficult to class this phenomenon apart
from hysterical somnambulism without complicating and
confusing all the psychological classifications. It is
only when the phenomenon which seems to you similar
to a fugue presents other characteristics which must be
studied, that you can frame for it another classification.
The second reason we must insist upon is that fugues
of this kind, exactly characterized, usually appear in
the life of some subjects who have had already, or who
will have later on, other phenomena connected with the
accidents we know as hysterical ones. In one word,
this kind of fugues appears usually in hysterical people.
This last point has called forth a number of interesting
debates. You must read for these discussions a paper
by Dr. J. M. Courtney, of Boston, in The Journal o]
Abnormal Psychology in August, 1906, p. 123. This
author quotes a number of fugues which seem to have
appeared in subjects who were formerly affected by
epileptic fits — in a word, in epileptic subjects. You
must discuss with great care the observations, you must
Fugues and Polyideic Somnambulisms 59
examine whether these fugues have exactly the same
character as the preceding ones. It is necessary, too, to
determine exactly the diagnosis of the fits which pre-
ceded the fugues, the diagnosis of epilepsy. As for
me, I cannot help saying that I often doubt these diag-
noses, that I am not sure of the diagnosis of epilepsy
in all the cases adduced by Dr. Courtney in his inter-
esting paper. But in the end, if you find a genuine
case of fugue, with all the preceding characteristics,
in a subject who is on the other hand an epileptic,
what do you conclude ? The neuroses are not definite
entities which exclude one another, they are only certain
classifications of facts. In my opinion, you must only
conclude that this subject, usually severely ill, usually
falling into serious epileptic fits, has once had a less
severe attack, which is connected with hysterical rather
than with epileptical phenomena. This is rather fre-
quent, and is not inconsistent with the important com-
parison we made just now of the phenomena of a fugue
and those of hysterical somnambulism.
However, we must not delude ourselves, we must
recognize differences. First, during the abnormal state,
the idea that develops has certainly not the same
power as during monoideic somnambulism; true, it
directs the conduct, but it does not bring on the halluci-
nations and deliriums that it produced in the preceding
case. When Irene had the idea of committing suicide
and of getting herself crushed by a locomotive, she had
not patience enough to go to the railway track and com-
pass a real suicide; she immediately had the hallucina-
tion of the railway track, and, without more ado, lay
60 The Major Symptoms of Hysteria
down on the floor of the room. Remember that differ-
ence : there is no real hallucination in the fugue. The
development of the idea is less intense. Secondly,
the idea is not absolutely isolated as in somnambulism ;
this is the most characteristic fact. Our great somnam-
bulists, you remember, do not see or hear anything
but what concerns the idea rooted in their mind; and
it could not be otherwise, for, if Irene saw the beds
in the room, if she heard my voice, she would not be-
lieve herself alone on a railway track. On the contrary,
the patients who make fugues need a great many per-
ceptions and recollections to enable them to travel with-
out any mishaps. " What is most wonderful in fugues,"
Charcot said, " is that these individuals contrive not to
be stopped by the police at the very beginning of their
journey." In fact, they are mad people in full delirium;
nevertheless, they take railway tickets, they dine and
sleep in hotels, they speak to a great number of people.
We are, it is true, sometimes told that they were thought
a little odd, that they looked preoccupied and dreamy,
but after all, they are not recognized as mad people;
whereas Irene could not take two steps in the street,
when she was dreaming of her mother's death, without
being immediately taken to the asylum. So you see
that the range of consciousness is not at all the same,
that the mind is not distinctly reduced to a single idea.
We can make the same remark concerning the state
called normal: the oblivion of the fugue is total,
but the oblivion of the directive idea and of the feel-
ing connected with it is by far less distinct, and the
restoration of the normal self is much more complete.
Fugues and Polyideic Somnambulisms 61
In short, the difference could, I believe, be explained
in the following remark: A fugue lasts much longer
than a monoideic somnambulism. While the latter
lasts a few hours at most, the former lasts for months
together. It is necessary for a fugue to be able to last
so long that the state should approach the normal
state, and that the character of somnambulism should
be attenuated.
Ill
In order to understand that degradation, that trans-
formation of monoideic somnambulism into the hysteri-
cal fugue, we must study states of mind which are in
some manner intermediate, and they will prepare us to
understand the transformations of typical somnam-
bulism. I mean polyideic somnambulisms, which are
opposed to the first, as their name shows, by the multi-
plicity of the ideas that fill them.
One instance will be enough to make you under-
stand how somnambulism can pass from one idea to
several. Here is an hysterical woman, Leg., who has led
a very eventful life, and has had several very dramatic
adventures, capable of upsetting her mind and filling
her head with those fixed ideas that lead to somnambu-
lisms. One day, at the period of her menstrual dis-
charge, she had searched her lover's desk and had found
a letter that confirmed her suspicions, showing her that
he had deceived her. She fell into a great passion ; her
menstrual discharge was stopped, of course, and she had
a crisis of delirium in the form of monoideic somnam-
bulism, during which she acted the scene over again.
62 The Major Symptoms of Hysteria
Another day, as she was taking a walk with her lover,
she had been surprised by a violent storm and fright-
ened by a very loud thunderclap. Her lover, it appears,
had not proved courageous, and had not been equal to
the task either of reassuring her or of finding a shelter
for her. She got terribly angry with him, had a violent
crisis of somnambulism, during which she heard the
thunderclap, fainted, and then made a scene with her
lover. That, again, is quite simple and conformable
to the rule. Now a third story. One day, again at the
period of her menstrual discharge, she stole a revolver,
placed herself in ambuscade on the roadside, and saw a
carriage pass by in which was her lover with her rival.
She shot at them, and fell back in a crisis of delirium.
Other adventures happened to her, the result of which
was the same.
After all these accidents, she was admitted into the
hospital, and nearly every day, on the slightest occasion,
she falls into crises of delirium. These crises begin at
hazard, by the recital or by the acting, as you please,
of one of her adventures. She has a haggard look,
trembles, and puts her hands before her face with an
expression of violent terror. She shuts her eyes as if
before flashes of lightning, and acts the scene of the
storm; then, suddenly, without awakening, her face
takes on another expression. She seems to be looking
for keys, breaks open drawers, reads letters, utters
shrieks of fury. Lastly, her hands grasp an imaginary
revolver, she looks out at the window with an infuriated
air, pulls the trigger, and falls back in a fainting fit.
These three scenes and others quite like them begin
Fugues and Polyideic Somnambulisms 63
over and over again indefinitely, succeeding one another,
but not always in the same order. They may last for
hours together. That is again a somnambulic state.
The mind is likewise concentrated on one idea, and
remains closed to external things. But the ideas are
manifold and bring on different comedies, during which
the perceptions and memories are not the same. The
unity of the somnambulism is broken; there is some-
thing foreign to the idea itself that has unified those three
or four ideas and has gathered them into one crisis.
The same character may be observed, though with
somewhat greater complication, in another form of
polyideic somnambulism. I take as a starting-point
the rather simple observation of a young girl twenty
years old, Ra. This young girl, as it appears, found a
situation at a tavern keeper's ; the man was very brutal,
and beat and abused her in every way. She got to look
upon him with abhorrence, and fell into crises of de-
lirium during which she acted over again the scenes
she had lived through in the tavern. The principal
one was a scene of rape; she shrieked and resisted the
brutal fellow. That is a monoideic somnambulism.
But, as she runs about the room, she finds a broom.
Immediately she takes it, and, keeping on her face the
same look of terror, she begins to sweep the room with-
out seeming to think in the least of the scene of the rape.
Another time, it appears, she found a wheelbarrow and
rolled it about the yard for hours. It is clear that the
act of rolling the wheelbarrow is not connected with
the thought of the rape. This is, as you see, a second
form of polyideic somnambulism, in which the ideas
64 The Major Symptoms of Hysteria
are not modified by the memory of previous somnam-
bulisms, but by the impression determined by outward
objects which the subject still perceives.
I could show you, as a third form, somnambulisms
in which the change of ideas seems to take place more
easily still: simply through an association of ideas.
Read again the amusing observation about the som-
nambulist of Mesnet already described in 1874. That
man had a very varied somnambulism, during which,
in turn, he acted scenes of military life, then played
music or fancied himself a servant, according to the
impressions he received. One idea, awakened by an
association, develops into a comedy; it awakens an-
other, then a third, and so on indefinitely. Somnam-
bulisms are thus very complicated sometimes, and
apparently filled with a great many different ideas.
But we must then ask ourselves what makes the unity
of these somnambulisms. Can we still apply here the
general conception which was simple in the cases of
monoideic somnambulism? We summed up those
states in a few words. There is a simple idea, a system
of images which has separated from the totality of
consciousness and has an independent development.
It brings about two things: a blank in the general
consciousness, which is represented by an amnesia,
and an exaggerated and independent development of
the emancipated idea. Now we find nothing of the
kind here ; we do not find one distinct idea, one precise
system that has emancipated itself from consciousness;
a great many different ideas seem to characterize the
somnambulism.
Fugues and Polyideic Somnambulisms 65
I think for my part that the difficulty lies on the sur-
face, and that at bottom the phenomena remain the
same. The psychological systems that exist in our
consciousness are very numerous, and they do not all
present themselves in the same form. No doubt
one of the simplest systems is the idea relative to an
event. The idea of one's mother's death is a well-defined
system which can be suppressed clearly or can develop
separately. But there are other vaguer systems, a
great number of which we shall have to study. I only
point out to you for the present the system of thoughts
and of tendencies that is called a feeling, or an emotion.
It is not so clear as an idea, but nevertheless it exists
with some unity. The feeling that arises from the fear
of an ignominious charge, the feeling of curiosity for
distant countries, the feeling of love and jealousy tow-
ards a lover, the feeling of bondage to a hated master,
— these are systems of thoughts that it is not always easy
to express in words, that are not ideas, properly so called,
that may on the contrary enclose very many different
ideas, but that nevertheless possess a mental unity.
Well, in polyideic somnambulisms and in fugues, it is
upon this more serious feeling that the dissociation has
borne. It is a feeling in its entirety, a more or less
precise feeling that has separated from general con-
sciousness, and that develops in an independent way,
giving birth to these odd deliriums. A certain com-
plexity differentiates these phenomena from somnam-
bulism, but we apply to them the same general law
and the same interpretation.
LECTURE IV
DOUBLE PERSONALITIES
The interest of the study 0} these rare cases — First type of
double existence, the "Lady oj MacNish" — The recip-
rocal somnambulisms — A graphic method for the represen-
tation of amnesias — Second type of double existence, Fe-
lida X. — The dominating somnambulisms — The group
of complex cases — A case of artificial double existence —
The true denomination of the different states — The oscil-
lations of mental level and the dissociation of a state of
mental activity
THE somnambulisms which we consider as the es-
sential phenomenon of hysteria are apt to present a new
metamorphosis, whose scientific interest is very great,
when they are so protracted and complicated as to give
rise to what is called double existences, double personali-
ties. I said scientific interest, rather than clinical and
practical interest, because this phenomenon is, upon
the whole, rather rare, and it is unlikely you will have
to occupy yourselves with it in practice. A celebrated
neurologist of New York — M. Dana — published in
1894 in the Psychological Review, p. 570, a compre-
hensive study on the most definite cases which have been
observed, and he counted only sixteen. In the last
66
Double Personalities 67
number of his Journal of Abnormal Psychology, p. 186,
Dr. Morton Prince gave a fine table of twenty cases, of
which he explained the most interesting features. Let
us suppose there are to-day twenty-five or thirty, — it is
certainly the total sum of the well-known cases. Such
cases are not often met with in usual practice ; however,
the importance of this fact is very great. Its very
exaggeration allows us better to interpret the preceding
states, and contributes very efficaciously to instruct
us on the theory of hysteria. Moreover, the question
presents for you, as it were, a national interest. For
some reason — why, I don't know — it is in America
that the greatest number of remarkable cases have
appeared, and it is American doctors, among them
MacNish, Wood, Weir Mitchell, Dana, and quite re-
cently one of the greatest physicians of this town,
Dr. Morton Prince, who have devoted to it the most
remarkable studies.
We cannot, in an elementary lesson, discuss the differ-
ent forms of this phenomenon and the various theories
which have been presented. I refer you for this sub-
ject to the recent book of Dr. Morton Prince, "Dis-
sociation of a Personality," 1906, and to that of MM.
B. Sidis and Goodhart, "Multiple Personality," 1905.
You will find in these works all kinds of psychological
discussions in which I should not like to venture. So
I shall confine myself to making three typical forms
known to you and to showing you in a few words in
what manner these new states, which present so many
interesting features, are connected with the preceding
somnambulisms.
68 The Major Symptoms of Hysteria
The type of double existences is given us by a cele-
brated case, more legendary than historical, published
in 1831, in a work of Dr. MacNish, entitled "Philosophy
of Sleep"; whose observation, it appears, dates still
farther back, since it is a question of a fact observed by
Mitchell and Elliot in I8I6.1 It shows you that this
observation is very old and very vaguely known.
This is perhaps the reason why the fact is presented to
us with a simplicity which astonishes us, and which we
no longer find in our observations of to-day. By
much repetition the fact must have become a great deal
simplified; however it may be, the following is the
abridged history of her who is called the "Lady of
MacNish."
A well-informed, well-bred young lady of a good con-
stitution was suddenly seized, without previous warn-
ing, with a profound sleep, which lasted several hours
longer than usual. On awaking, she had forgotten
all she knew ; her memory was like a tabula rasa, and
had preserved no notion either of words or of things;
it was necessary to teach her everything anew. Thus
she was obliged to learn again reading, writing, cipher-
ing. Little by little she became familiarized with the
persons and things surrounding her, which were for
her as if she saw them for the first time. Her progress
was rapid. After a rather long time she was, without
any known cause, seized with a sleep similar to that
1 "The Medical Repository," 1816.
Double Personalities 69
which had preceded her new life. On awaking, she
found herself exactly in the same state in which she
was before her first sleep. But she had no remembrance
of anything that had passed during the interval. In a
word, in the old state she was ignorant of the new state.
It was thus that she called her two lives, which were
continued separately and alternatively through remem-
brance. During more than four years this young
lady presented these phenomena almost periodically.
In one state or in the other, she did not remember her
double character, any more than two distinct persons
remember their respective natures; for instance, in
the periods of her old state, she possessed all the knowl-
edge she acquired in her childhood and youth; in her
new state, she knew only what she had learned during her
first sleep. If a person was presented to her in one of
these states, she did not know this person in the other
state, but was obliged to study and know him in both
to have a thorough notion of him. And it was the
same with everything. In her old state she had a very
fine handwriting, the one she had always had, while in
her new state her handwriting was bad, awkward, as it
were, childish, because she had neither the time nor
the means to perfect it. As has been said above, this
succession of phenomena lasted four years, and Mrs. X.
was accustomed to it, and had succeeded easily in
maintaining an intercourse with her family.1
In connection with this case, I should like to avail
'In connection with this case, see Azam, "Les alterations de la
personality, in Revue scientifique, 1883, II, p. 616, and id., "Hypno-
tisme et double conscience," 1893, p. 136.
yo The Major Symptoms of Hysteria
myself of the opportunity to lay before you a graphic
method which I once invented and of which I make
great use in my lectures before the French students.
This schema, I believe, enables us to represent to our-
selves the various disturbances of memory in a very
simple manner and makes their different varieties
clearly perceptible to the eye. No doubt you are al-
ready accustomed, in your courses of medicine, to the
little schemata which are made use of to represent the
various lesions of the organs, and especially to repre-
sent the disturbances of sensibility. There existed no
schemata of this kind for the disturbances of memory,
for we have to deal with a considerable difficulty of rep-
resentation. There are, indeed, in a remembrance or
in an oblivion two different things which must be rep-
resented simultaneously. We must first consider the
time when the remembrance exists: for instance, it is
to-day that I remember the studies on double conscious-
ness ; this is the date of the appearance of the remem-
brance. We must also consider in a remembrance the
past period to which it refers; I remember, to-day in
1906, that I already came in Boston in 1904; it is
the period to which the remembrance refers. To
represent these two things simultaneously, I propose
to you the following schema, which is described in my
book on Nevroses et I dees fixes, 1898, Vol. I, p. 124.
The horizontal line OX in all these Figures 2, 3, 4, 5,
from the left to the right, designates the different
periods of the course of life in their order of appearance.
It is on this line that we inscribe the remembrances at
the moment of their appearance. The vertical line OF,
Double Personalities 71
from the bottom to the top, represents the same periods,
but as remembrance, as representation. At each point
of the horizontal line we draw a perpendicular parallel
to the vertical line which represents the remembrances ;
its height represents the number of remembrances one
"December
FIG. 2. — Schema of a case of retrograde amnesia: case of Kaempfen,
possesses at such or such a moment. As this height
naturally increases as life passes away, and one can
theoretically call up more remembrances, normal
memory will be represented by this triangle, whose
base is the horizontal line OX, and which is formed by
72 The Major Symptoms of Hysteria
the diagonal drawn from the point O. If you have to
represent oblivions, amnesias, you will mark a black
spot above the point representing the date at which this
accident took place, and the height of this black spot
will be determined by the parallel line which meets on
the vertical the forgotten remembrance. This figure,
not very complicated, upon the whole, allows us to rep-
resent the different amnesias in a very clear and striking
manner.
As examples, and in order to accustom your eyes to
these schemata, which are very useful in clinical studies,
I put before you various figures representing the more
usual forms of amnesias which you will meet with in
your practice. You have already studied with your
masters of neurology and psychiatry the retrograde
amnesia (Figure 2) which, beginning after some physical
or moral shock, takes away all the memories of the pre-
ceding time; you know, too, the continuous amnesia
(Figure 3), wiping out the remembrances of events
as life goes on, continuously.1 You see that the general
aspect of the schema is quite different, and that it puts
into evidence the differences between the two diseases of
the memory.
We can now apply this method of representation to
the double existences we were studying. In Figure 4 I
have drawn a figure representing the case of the "Lady
of MacNish," and you see that it is very characteristic.
It is a kind of draught-board, in which black and white
squares alternate very exactly. You will remark, in
1 See "L'amnesie continue," in Nevroses et I dees fixes, 1898, I,
p. 109.
Double Personalities
73
fact, that in this singular history the oblivions and
remembrances alternate in the same way very regularly.
In the state called state No. i, the "Lady of Mac-
Nish" does not remember the state No. 2 at all; in
the state No. 2 she does not remember the state No. i
1891 Ma;
MJ JA80NDJ PMAMJJ A BOND JF MAM J JASON DJ FMAUJ JA80NDJ
1891 1892 ,.1893 180* 1896
FIG. 3. — This scheme represents all the modifications of the memory during
four years of a patient, Mrs. D., presenting continuous amnesia after a
shock of emotion.
at all. When she comes back to the state No. i, she
remembers only this state and nothing more. It is the
same when she comes back to the state No. 2. There
is in the disease a perfect alternation which the schema
illustrates very well by its draught-board, and which
is quite peculiar to this type of patients. I have pro-
74 The Major Symptoms of Hysteria
posed to call this form of somnambulisms, " reciprocal
somnambulisms." l
Double existences of such a simple form are very
rare. It very seldom occurs that the subject in his
abnormal existence has entirely forgotten his normal
existence, and that in the latter he has likewise entirely
forgotten the other period. This absolute division of
life into two alternating periods which do not know
each other at all is quite exceptional: we can connect
only a small number of cases with the type of the " Lady
of MacNish." The case of Dana is perhaps of this
kind, but at all events the disease lasted a much shorter
time. Two cases of Charcot, that of Marguerite D.
and that of Habillon, which you will find published in
the last two volumes of his works, and which have been
reported by M. Guinon, approach this form. But
certainly the finest modern case analogous to that of
MacNish appears to me to be the history of Mary
Reynolds, published by Dr. Weir Mitchell in i888.2
Mary Reynolds was an intelligent, calm child, rather
reserved and melancholy, but of apparent good health.
The nervous disturbances began towards the age of
eighteen with a rather protracted syncope, after which
she remained for five or six weeks blind and deaf. The
sense of hearing returned all at once, the sense of sight
1 The reciprocal somnambulisms in " L'etat mental des Hyste"-
riques," 1894, II, p. 197; "The Mental State of Hystericals," trans-
lation by Mrs. C. R. Corson, New York, G. P. Purnam's Sons, 1901,
p. 419.
2 S. Weir Mitchell, " Mary Reynolds, a Case of Double Con-
sciousness," in The Transactions of the College of Physicians of Phila-
delphia, April 4, 1888.
Double Personalities
75
State I
U
II
II
FIG. 4. — Schema of the reciprocal somnambulisms in the case of the
" Lady of MacNish."
returned gradually and completely. We need not dwell
now on these sensorial disturbances, which we shall
study later on. After p, second syncope, which lasted
from eighteen to twenty hours, she awoke, apparently
with all her senses, but she had forgotten all her former
life and all the knowledge previously acquired ; nothing
was left her but the power of instinctively pronouncing,
like a child, a few words, without understanding them.
She was obliged to learn everything anew. But it
76 The Major Symptoms of Hysteria
must be acknowledged that her education was rapid,
since, after a few weeks, she could again speak, read, and
write. It was noticed that she learned again to write
in an odd manner: she handled her pen awkwardly,
and began to copy from the right to the left, after the
manner of the Orientals. She always kept, in this
second existence, an inverted handwriting very different
from her ordinary handwriting In this second existence
her character was quite transformed : she had become
lively, cheerful, was no longer afraid of anything,
wandered about the woods, played with dangerous
animals; she dealt shrewdly with and mocked at the
persons who wanted to direct her, and, in reality, no
longer obeyed anybody. After about ten weeks she
again had one of those strange sleeps, and awoke of
herself in the first state. She no longer had any re-
membrance of the period which had just elapsed, but
she recovered her previous knowledge and character.
She was slower and more melancholy than ever.
After some time, the same -accident caused her to
return to the state which appeared to be the second.
These transitions often took place in the night during
her natural sleep, sometimes in the daytime, and they
were often painful. The subject was, as it were,
frightened by a kind of feeling of death, "as if I were
never to return into this world." When the second
existence reappeared, Mary Reynolds was again exactly
in the state in which she had been at the end of the
corresponding period, with the same acquired knowl-
edge and the same remembrances; but she again
forgot everything when she returned to the state No. i.
Double Personalities 77
About the age of thirty-five or thirty-six, the state
called No. 2 became definitively predominant. It was
reproduced more often, lasted longer, and at length
became in a manner definitive, since she remained
twenty-five years in this state. The author remarks
that, at the end of her life, there seemed to be a kind
of confusion between the two states; at least the state
No. 2, which had become preponderant, expanded, and
seemed vaguely to acquire remembrances belonging to
the state No. i. "It seemed to her that she had, as
it were, an obscure, dream-like idea of a shadowy past
which she could not quite grasp."
You see that, in general, the observation of Mary
Reynolds is the one which most approaches that of
the "Lady of MacNish, " and which best presents the
two existences quite independent of each other. How-
ever, even in this case, you remark, at the end of life,
a tendency of the state No. 2 to encroach upon state
No. i. This will be found to be the essential char-
acteristic of another form of double existence much
more common than the first.
II
I have given to this new form the name of domi-
nating somnambulism, because one of its essential
features is that one of the states dominates the other.
In this state, the subject is more active, more lively,
more intelligent than in the other, and what is particu-
larly important, the memory, during this state, is much
more extended than in the other.
78 The Major Symptoms of Hysteria
If America can boast of having presented in the
person of the "Lady of MacNish" and in that of
Mary Reynolds the finest examples of the first form, the
history of Felida X. gives now to France an unques-
tionable superiority. Allow me to make you acquainted
with Felida. She is a very remarkable personage who
has played a rather important part in the history of
ideas. Do not forget that this humble person was the
educator of Taine and Ribot. Her history was the
great argument of which the positivist psychologists
made use at the time of the heroic struggles against
the spiritualistic dogmatism of Cousin's school. But
for Felida, it is not certain that there would be a profess-
orship of psychology at the College de France, and
that I should be here, speaking to you of the mental
state of hystericals. It is a physician of Bordeaux who
has attached his name to the history of Felida : Azam
reported this astonishing history first at the " Society
of Surgery," then at the " Academy of Medicine," in
January, 1860. He entitled his communication, " Note
on Nervous Sleep or Hypnotism," and spoke of this case
in connection with the discussion of the existence of an
abnormal sleep during which it would be possible to
operate without pain. And this communication, thus
incidentally made, was to revolutionize psychology in
fifty years. Subsequent to that time, Azam under-
stood better the interest and success of his observation ;
he published various memoirs, and even books on this
subject, in 1866, 1876, 1877, 1883, 1890. As I told
you, first Taine, in his book on " Intelligence," then
Ribot, in his " Diseases of Memory," took possession
Double Personalities 79
of this history, which has gone round the world, and
to-day there is a whole library written about this poor
woman.
When Azam first knew Felida in 1858, she was already
fifteen years old, and had already been ill for three years
since the appearance of puberty. This frequently
occurs in hysteria, as you will see later on. She had
all kinds of hysteric accidents, attacks of motor agita-
tion, disturbances of alimentation, which we need not
examine now. All kinds of sufferings had changed
her character for the worse ; she was a reserved, melan-
choly, and timid person. She had a great number of
disturbances of sensibility, consisting both of pains
and diffuse insensibilities.
Among all these miseries, there appeared from time
to time, rather infrequently at the beginning, another
very strange phenomenon. She seemed to faint away
for a very few minutes; it is the transition we have
already remarked in most somnambulisms. Then
she would wake up suddenly, become gay and active,
and bustle about, without any anxiety or pain ; she no
longer had those painful sensations or those insensi-
bilities which troubled her before, and she was in much
better health than in the preceding period. But let us
immediately remark that in this apparently new state
she by no means presented the characteristic disturbance
of the "Lady of MacNish" and of Mary Reynolds.
She had nothing to learn again, because she had for-
gotten nothing: she preserved a very clear remem-
brance of all her former life, of all the sufferings she
had undergone, and of all she had learned before.
8o The Major Symptoms of Hysteria
So everything went quite well ; but this state of comfort
lasted but a short time. After one to three hours, she
had a new syncope, and then awoke in the preceding
state, considered as normal, which we may call, accord-
ing to Azam's convention, the prime state. On return-
ing to this state, she resumed again all her infirmities,
and the slow, melancholy character which was her
usual one. But there was now one phenomenon more :
she had quite forgotten the few preceding hours filled
by the state No. 2, or the lively state. All this period
was for her as if it did not exist.
This caused no great inconvenience at that time, since
the state called No. 2 occurred only from time to time
and lasted an hour or two. But, little by little, this
state developed singularly ; it lasted for hours and days,
and as the subject was now much more active, it was
filled with all kinds of serious incidents. You will
read in Azam the strange narrative of that consultation
about the first pregnancy of Felida. The poor girl,
during her period of excitation and gayety, had given
herself up to a young man who was to be her husband.
The awakening occurred shortly afterwards, and did
not leave her the least remembrance of this incident.
As her health was impaired, and her abdomen grew
bigger, she naively went to consult M. Azam about the
strange disturbances in her health. "The pregnancy
was evident," says Azam, "but I dared not make it
known to her." Some time after, the state No. 2
returned, and Felida, addressing herself to the physi-
cian, laughingly apologized for her preceding consulta-
tion, for she now knew very well what was the matter.
Double Personalities 81
During the greater part of her life, these two periods
alternated, and it was only in her old age that one of the
two periods, the second, — that is to say the better one, —
during which the subject was more active and had a
total memory, encroached upon the first and filled
almost the whole of her life. Henceforth Felida
seldom remained three or four days in her former state,
called normal; but then her life was intolerable, for
she had forgotten three-quarters of her existence, and
this gave rise to the most comical situations. She feared
to pass for mad, and in her anguish hid herself till a
new syncope restored her to her better state, which
was now her habitual one.
Such are the chief features of this history, which has
become celebrated. You may easily see wherein it
differs from the preceding observations. The sche-
matic figure (Figure 5), which you can now understand,
gives you quite a characteristic image. It is no longer
a draught-board on which the periods of oblivion regularly
alternate with the periods of remembrance. You see
regularly entire light-coloured stripes, which are broader
and broader as life advances, in which there is no black
spot; they are the periods of the state No. 2, during
which the memory extends over the whole of life with-
out any amnesia. On the contrary, in the intercalary
stripes representing the state No. i, you see series of
black spots representing more and more extended
amnesias affecting the periods of life which were filled
by the state No. 2. This figure clearly shows you that
the two somnambulisms are not equal, that one is
superior to the other, especially as regards the memory;
82 The Major Symptoms of Hysteria
this is what justifies the name of dominating somnam-
bulisms1 which I have given to these cases.
If the cases of the first kind, grouped around the
"Lady of MacNish," are rare, this is not true of those
FIG. 5. — Schema of the dominating somnambulism in the case of
Felida X.
of the second group, which have Felida for type; the
case of Ladame, that of Verriest (1888), of Bonamaison
(1890), of Dufay (1893), and many others could be
described from the same model. It is of no use to
1 " The Mental State of Hystericals," translation, p. 422.
Double Personalities 83
dwell upon this. These cases do not present any really
new psychological phenomena.
But it would be well to form a third group, which
might be called the group of complex cases, in which
some celebrated observations ought to be placed. I
allude to the complicated cases of patients who have
not two forms of existence, but a very great number
of forms of existence, as many as nine or ten. These
different psychological states offer very various rela-
tions with one another; sometimes they are quite
independent of one another and present a simply
reciprocal memory; the subject only finds again the
remembrances of the state No. i when he comes back
to the state No. i, but he by no means remembers
this state when he is in the state No. 2 or in the state
No. 4. But such patients have besides, and at the
same time, other states obeying another rule. For
instance, they are apt to enter into a particular state,
which we shall call No. 3 in which they not only re-
member the other periods of the state No. 3, but also
remember the periods of the state No. i and of the
state No. 2. In a word, they have reciprocal som-
nambulisms and dominating somnambulisms.
One of the most remarkable cases published in France
is that of Louis Vivet, studied from 1882 to 1889 by
many authors, by Legrand du Saulle, Voisin, Mabille
and Ramadier, Bourru and Burot. This boy has six
different existences. Each of them is characterized,
first, by modifications of the memory affecting now
one period, now another; secondly, by modifications
of character; in one state he is gentle and industrious,
84 The Major Symptoms of Hysteria
in another he is lazy and irascible ; thirdly, by modifi-
cations of sensibility and of motion; in one state he
is insensible, and paralyzed in his left side ; in another
he is paralyzed in his right side ; in a third he is para-
plegic, etc. An English author, Mr. Arthur Myers,
the brother of the well-known psychologist, in an article
in the Journal of Mental Science, January, 1886, tried
to group in a table these four modifications, charac-
terizing each state. The most curious fact of this state
is that one can, by acting on this third character, bring
about the corresponding modifications of the other two.
If one cures the paralysis of his two legs, one causes him
to enter into the state in which he has all his sensations
and movements, and then one sees the character and
state of memory corresponding to this period reappear.
But these facts are especially interesting from the
point of view of the artificial reproduction of somnam-
bulisms and even of second existences. We need not
dwell on them to-day.
After having reported this French case, let us consider
some very remarkable American observations. One of
the most astonishing observations, whose scientific value,
unfortunately, I can hardly appreciate, is that which
was published in 1894 under the rather strange title
of "Mollie Fancher, the Brooklyn enigma; an authentic
statement of facts in the life of Mary J. Fancher, the
psychological marvel of the nineteenth century; un-
impeachable testimony by many witnesses, by Abra-
ham H. Daily, 1894." The history is strangely related ;
you feel in it a kind of mystic admiration for the
subject, an exaggerated seeking after surprising and
Double Personalities 85
supranormal phenomena, which of course inspires
you with some fear as to the way in which the observa-
tion has been conducted ; it nevertheless contains many
very remarkable and interesting facts. Mollie Fancher,
who seems to have had all possible hysterical accidents,
attacks, terrible contractures lasting for long years,
more or less complete blindness, etc., above all pre-
sented all the forms of somnambulism, from the simplest
to the most complicated ones. There are in her at least
five persons, who have very poetical pet names: Sun-
beam, Idol, Rosebud, Pearl, Ruby, each one with her
.remembrances and her character. The complication
of this case is very amusing.
Lastly, we have to point out the last and most re-
markable of the observations of this kind, the observa-
tion of Miss Beauchamp, by Dr. Morton Prince, one of
the physicians of Boston who have most interested
themselves in the development of pathological psy-
chology, and who devoted years of work to the obser-
vation of this complicated and interesting case. We
cannot here enter into analysis of these complex cases
which, moreover, are but various combinations and
forms of the two simple forms we have studied. In
these complex cases a new influence usually makes
itself felt which complicates matters a great deal. I
mean the influence of the observer himself, who, in the
end, knows his subject too well and is too well known
to him. Whatever precautions one may take, the
ideas of the observer in the end influence the develop-
ment of the somnambulisms of the subject, and give
it an artificial complication. However it may be, I
86 The Major Symptoms of Hysteria
must add the study of these complex cases to the two
simple forms I have pointed out, in order to make you
understand all the developments which may be taken
by this strange phenomenon of multiplex personality
in hystericals.
Ill
We cannot enter into the psychological study of all
the problems raised by the double existences of hys-
tericals. Besides, I have pointed out to you some
works published in this very city, in which you would
find these discussions very well conducted. I only
wish, before concluding this lecture, to give you a few
indications as to the direction which, in my opinion,
these studies should take, and as to a general concep-
tion of these apparently mysterious phenomena.
Let us take up one more observation of a double
personality, which differs from the preceding ones
only by a singular slight detail ; namely, that it was, for
a great part, produced artificially. Long ago, in 1887,
a young woman of twenty, whose name was Mar-
celine, entered the hospital in a lamentable state.
For several months past she had not taken any food ;
first, because she obstinately refused to eat, then because
she immediately vomited any food or drink one forced
her to swallow. Besides, she no longer had any func-
tion of evacuation; she was incapable of urinating
spontaneously, and sounding alone could cause her to
discharge a few drops of urine. In these conditions,
this young woman, who had reached the last stage of
emaciation, seemed to have but a breath of life left;
Double Personalities 87
she remained constantly lying in her bed, being inca-
pable of standing. Her mental activity was as much
reduced as her physical activity; she was completely
insensible on the whole surface of her skin and on all
her mucous membranes; she heard very badly, and
saw but exceedingly little. Though she looked intelli-
gent, she replied with great indifference to the ques-
tions put to her, and seemed to be in a serious state
of stupefaction. As we did not succeed in nourishing
her otherwise, we had to try the effect of hypnotic
practice.
After some attempts, we easily caused her to enter
into a singular state, which appeared momentary
and artificial, but differed altogether from the habitual
state in which we had constantly seen her since her
entrance into the hospital. She looked quite trans-
formed physically and morally. She was now capable
of moving, she accepted any food, and had no longer
any vomiting. Lastly, she urinated spontaneously,
without difficulty. On the other hand, she had become
sensitive over her entire body, and could hear and see
perfectly ; she expressed herself much better, with more
vivacity, and showed a complete memory of all her
anterior life. After having nourished her in this new
state, we thought it necessary to awaken her, since this
state was considered artificial. She immediately fell
back into her preceding state. Inert, insensible, unable
to eat or urinate, she simply presented one more dis-
turbance; namely, according to the law of somnam-
bulisms, which you know, she had quite forgotten what
had happened during the preceding period.
88 The Major Symptoms of Hysteria
Nevertheless, thanks to these artificial somnambu-
lisms, we were able to nourish her and cause her to
recover her strength. But it was always impossible
to make her eat in the period considered normal, which
we always brought back by awakening her. So that,
tired of thus putting her to sleep at each meal, which
was very long, we left her for whole days in the artificial
state. The only result was apparently a great advan-
tage, since all day she ate well, urinated completely,
and presented more sensibility, memory, and activity.
One day her parents, finding her in this fine artificial
state, considered her cured, and took her out of the
hospital.
Everything went well during the first days ; but, after
a few weeks, on the occasion of her menstrual period,
she experienced a kind of upsetting, and awoke spon-
taneously, that is to say, she suddenly returned to the
state of depression and stupefaction from which we
had drawn her, but she presented, in addition, a for-
getfulness bearing, this time, on whole weeks. She
was very much bewildered at finding herself in her
house without understanding how she had left the
hospital, for she did not remember the events of the
preceding days. Besides, she again refused to eat, and
could not urinate. Marceline was brought back to
me, and, in the presence of all these disturbances,
which were well known to me, I could do nothing else
but put her to sleep again, or rather bring her back to
her artificial state.
Well, gentlemen, things continued in this way fc r fif-
teen years. Marceline would come to me in order to be
Double Personalities 89
put to sleep, enter into her alert state, and then go away
very happy, with complete activity, sensibility, and
memory. She would remain thus for a few weeks;
then, either slowly or suddenly, in consequence of
some emotion, fall back into her numbness, return
to the state we had considered primitive and natural,
with the same visceral disturbances. The forgetful-
ness now extended over whole years, and disturbed
her existence completely. She would hasten to come
to me to get herself transformed again. Things con-
tinued thus for years together, till the death of the
poor girl, who succumbed to pulmonary tuberculosis.
How are the two states of Marceline to be explained ?
You see they are quite like what we have just de-
scribed in connection with the dominant somnam-
bulisms of Felida. The latter also had two states,
one melancholy and incomplete, in which she had
great oblivions ; the other, alert, in which she found again
all her sensibility and memory. Marceline resembles
her so much that I have already proposed to call her
an artificial Felida. We ought, then, to apply to her
the conventions proposed by M. Azam, as well as by all
the authors, to designate these two states. We ought
to say that the state No. i is the state of depression in
which we found her at the beginning and which looked
normal ; that the state No. 2, a superadded or artificial
state, is the alert state with complete memory.
Well, these denominations seem to me quite incorrect
when applied to this case, which I followed so long. It
is absurd to call state No. i, — a state of mental depres-
sion incompatible with life, — a natural state ; it is un-
90 The Major Symptoms of Hysteria
likely that this young woman has always been, from the
first, in such a state. In reality, it is false : she began
by having in her girlhood, before puberty, all these sensi-
bilities, all these functions at her disposal. She ate
and digested very well, and urinated spontaneously.
This is the real state No. i. There is no doubt on
this point. The state in which we saw her in the
hospital, with all her disturbances and insensibilities,
is an abnormal state brought on by illness, by hysteria,
which had evolved since her puberty. It is the state
No. 2.
But what shall we do, then, with the state obtained
through hypnotism, which was produced artificially?
Is it a state No. 3 ? By no means. In this state her
functions were normal; she recovered the sensibility
and memory she had formerly had. I see no reason
why we should distinguish this state from the natural
state of her childhood, which we called state No. i.
It is simply a momentary cure, which we brought
about through processes of artificial excitation. And
when she falls back into the state No. 2 it is simply
because the disease begins again.
All this history may be represented by the following
diagram. Slowly, without its being perceived, this
young girl grew worse every day; she had gradually
lost sensibility and memory. We may represent this
stage by a line which descends well below the line AB
of normal activity (Figure 6). When she has been hyp-
notized in C, she rises again to a state of almost normal
activity in D. Through the effect of illness, she gradu-
ally redescends. At first she seems to awaken a little
Double Personalities
91
as soon as you leave her, and forgets what you have
just now told her, E. Then, two days after, she wakes
again, F, that is to say, she experiences a fall into a
state of hysterical anesthesia and amnesia still deeper
than before, G; she forgets the two preceding days.
*-..yc
FIG. 6. — Diagram of the oscillations of mental level in the case of
Marceline.
Then she goes down very slowly. If you let her fall
again by an emotion, for instance, there will be complete
amnesia of the whole preceding period. If you excite
her, there will be, on the contrary, a psychological state
far more complete, and a total remembrance of the
preceding periods. It is these falls, these returns to
anesthesia, which give to the normal periods the aspects
of somnambulisms.1
I think it is absolutely the same with all such cases,
that everything has been confused through false de-
nominations. Felida also had in her childhood a
state No. i, which now no longer exists, except in her
periods of alert state, improperly called state No. 2.
It has been noticed with astonishment that, at the end
of her life, this state exists almost alone; it is simply
because the hysteria is cured, and she returns to the
normal state of her girlhood, which she ought always
1 "The Mental State of Hystericals," translation, p. 449.
92 The Major Symptoms of Hysteria
to have kept. There is nothing abnormal but the state
of depression with amnesia, which settled gradually
after her puberty, and which was mistaken for a state
No. i, because it had lasted for a long time when the
subject was observed.
In this view things become somewhat clearer; the
essential phenomenon that, in my opinion, is at the
basis of these double existences, is a kind of oscilla-
tion of mental activity, which falls and rises suddenly.
These sudden changes, without sufficient transition,
bring about two different states of activity: the one
higher, with a particular exercise of all the senses and
functions ; the other lower, with a great reduction of all
the cerebral functions. These two states separate from
each other; they cease to be connected together, as
with normal individuals, through gradations and
remembrances. They become isolated from each other,
and form these two separate existences. Here, again,
there is a mental dissociation more complicated than
the preceding ones. There is dissociation, not only
of an idea, not only of a feeling, but of one mental state
of activity.
LECTURE V
CONVULSIVE ATTACKS, FITS OF SLEEP, ARTI-
FICIAL SOMNAMBULISMS
A great number of convulsive attacks and of fits of sleep
are nothing but imperfect somnambulisms — The associa-
tion of ideas in the hysterogenic points — The diagnosis of
hysterical and epileptical fits — The crisis of emotional
manifestation — The different fits of sleep, the lethargies —
The perseverance of thought during this sleep, the crisis of
revery — The artificial reproduction of hysteric accidents,
of attacks, of fits of sleep — Artificial somnambulism or
hypnotism — The hypnogenic points — The hypnotic
state as a reproduction of hysteric somnambulism
ALL the preceding examples — the study of monoideic
and polyideic somnambulisms, the study of fugues and
of double existences — showed you the considerable
importance assumed by somnambulisms in hysteric
neurosis. We should still have many forms of the same
phenomenon to consider. But to-day I wish only to
dwell on certain elementary and, in some manner,
degraded forms of somnambulism, because they are
common, because they are to be met with every day, and
because it is necessary, in order to understand them, to
be able to connect them with the more typical somnam-
bulism, of which they are only inferior forms. You
will understand the interest of this study, if you notice
93
94 The Major Symptoms of Hysteria
that it first applies to two phenomena very important
in practice, — convulsive attacks and fits of sleep.
I hasten to tell you that I do not vaguely connect all
hysteric attacks and all fits of sleep with phenomena
of somnambulism. The words "attack" and "sleep"
are vague words, borrowed rather from the vulgar
than from scientific language, and very varied phe-
nomena are ranged under them. You will soon see,
on the occasion of motor agitations, that the hysteric
attack is often constituted by an ensemble of tics, of
choreic movements, connected together in a certain
manner. Sometimes fits of sleep are simply paralytic
phenomena; the subject is incapable of moving, but
hears and understands very well and has no intellec-
tual disturbance. So we shall meet later on with many
other forms of attacks and fits of sleep, but to-day we
are to study one of the most essential forms, in which
these two accidents are nothing but particular aspects
of certain imperfect somnambulisms.
Convulsive attacks, which we have first to attend to,
are exceedingly frequent phenomena ; they were noted
even by the philosophers and doctors of ancient Greece.
It is this phenomenon that the Middle Ages and the
Renaissance reproduced in the documents relating to
exorcisms. Modern authors, such as Briquet, state in
their statistics that three-quarters of their patients have
attacks.
At first sight, the patients, who seem to have become
Convulsive Attacks 95
unconscious, and writhe in disorderly convulsions,
appear to be very different from the somnambulists
we have just studied. Complete somnambulism was
evidently characterized by a great number of intelli-
gent manifestations; the subject expressed his idea,
his dream, by his adjusted movements, which usually
are to our mind the expression of reasonable thoughts.
The first and clearest of these expressions was speech,
and we had no great merit in guessing the subject of
such dreams, since the patient expressed it himself
by language. When he did not speak, he had ex-
pressions of the physiognomy, attitudes, and especially
acts, the interpretation of which was very clear; he
was seen to get up, to walk, to seek for objects in a
drawer, to make the gesture of holding a revolver and
pulling the trigger, to struggle with phantoms, etc.
In a word, the outer expression of the somnambulic
idea was as clear as possible. There is nothing of
the kind in convulsive attacks, in which the subject
seems to writhe in great, irregular, apparently meaning-
less movements.
Yet it is easy to prove that, from many points of
view, these convulsive attacks approach somnam-
bulisms. These accidents, though apparently con-
stituted by uncoordinated movements, have the same
moral causes as somnambulisms ; they begin, like them,
on the occasion of particularly affecting events, genital
perturbations, sorrows, fears, etc. A man begins to
have crises of hysteria because he has seen his son fall
from a scaffolding and die before him; many girls
or women begin to have attacks on the occasion of the
96 The Major Symptoms of Hysteria
death of a beloved person; in about ten observations,
the cause of the first fit is a conflagration, a petroleum
lamp setting the subject's dress on fire; in others, it
is a fall from a tram car or from a bicycle, a fight with
comrades, heart-grief, reverses of fortune, etc. I wish
to dwell only on one story, that of the woman with the
dog, which affords a fine example of attacks displaying
the form of imperfect somnambulism, joined with tics,
to which we shall allude later on. This lady, forty-
three years old, who had always been impressionable,
of course, was already very much upset by the death
of a very dear friend ; she had kept only one souvenir
from him, a very precious souvenir, an old dog. Now,
two years after his master's death, the dog died, in his
turn, on a carpet. This lady, in despair, lay down on
the carpet on which the dog had died, and remained
there for sixty days without consenting to accept any
food or to take any care of herself. From that time she
began to have terrible fits of hysteria, which assumed
many forms. You see by this example that the start-
ing-point of convulsive attacks is the same as that of the
preceding somnambulisms.
Let us go one step farther and consider the occasional
cause that determines the appearance of each new
attack ; it is easy to see that here, again, moral causes
play an important part. It is true the patient main-
tains that the fit occurs irregularly, without her know-
ing why, and that it is brought on solely by physical
causes. There may be some truth in the remark that
the time which has elapsed since the last attack plays
a great part. When patients have just had their fit
Convulsive Attacks 97
of somnambulism or convulsions, they cannot always
begin a new attack immediately. They seem to be
modified, and to have become less sensitive to the vari-
ous moral impressions; a certain time must elapse —
two days for one, a week or a month for another — be-
fore they become very impressionable and capable of re-
commencing the same phenomenon. This is true ; we
meet here with a very interesting periodical oscillation,
which we shall have to take into account at the end of
this course of lectures. But besides this general pre-
disposition, it is none the less true that a thousand
accidental circumstances bring about the appearance
of the fit. First of all, slight exterior phenomena
may produce this effect. The sight of a flame, some-
times of a match only, brings about the fit with those
subjects who have been affected by a conflagration;
any cry, or name, or sentence, will call it back with
others. Our woman with the dog is admirable in this
respect: it is enough that a dog barks in the street,
she sees a cat pass by, the name of one of the animals
is pronounced, or even certain words are pronounced,
the use of which she absolutely forbids, as the words
"love," "affection," "happiness," etc. It is enough
that a date on the calendar be mentioned before her,
for the fear of remembering a certain date has caused
her to forbid all possible dates. The least thing is
enough to bring about an endless fit, in which convul-
sions and howlings mingle together for fifteen or twenty
hours. Is it not obvious that, in all such cases, there
is an association of ideas between the dreaded percep-
tion and the remembrances which bring on the fit as
98 The Major Symptoms of Hysteria
well as the somnambulism? The different terms of
these systems of ideas are connected together in such
a manner that they mathematically call up one another.
You would perhaps find it more difficult to recognize
the same law if you considered attacks, the starting-
point of which seems to be the touch or excitation of
a point of the subject's body. You know that formerly
great importance was attributed to such points, which
were called hysterogenic points. Charcot and Pitres
wrote a long disquisition about them, which nowadays
seems to contain many errors. It was admitted that
the fit began with a pain or a strange sensation situated
at such or such a point of the body ; the most frequent
points with women were the lower region of the abdo-
men, called the ovarian region, on either side. Pains at
this point at the moment of the fit were so frequent
that they even determined the theories of the ancients
on hysteria. You remember the absurd story invented
by Plato, which spread all over the world, obnubilating
the minds of physicians for centuries, and casting a
kind of shame on all such patients. It was, he said,
the overexcited matrix which required satisfaction,
and as this satisfaction was not obtained, it Ascended
through the body as far as the throat of the patients
and choked them. In fact, this sensation of uneasiness,
which often begins in the lower part of the abdomen,
seems to ascend and to spread to other organs. For
instance, it very often spreads to the epigastrium, to
the breasts, then to the throat. There it assumes
rather an interesting form, which was for a very long
time considered as quite characteristic of hysteria.
Convulsive Attacks 99
The patient has the sensation of too big an object,
as it were, a ball, rising in her throat and choking her.
She makes an effort either to swallow or to expel this
big object. Other points and sensations may intervene,
irregularly situated in the breast, shoulders, eyes, or
head, and they seem to depend on purely physical
phenomena.
Do not misunderstand the nature of such points.
First, they never correspond to real organic lesions, or,
at least, if there are any lesions, they play no part in
hysteria, properly so-called. Then, in spite of appear-
ances, try to realize thoroughly that these sensations
are moral, not physical, ' and that they also depend on
the ideas and emotions of the subject. For you must
not forget that the different regions of our body par-
ticipate in all the events of our life and in all our senti-
ments. Let us consider two individuals, both of them
wounded in the shoulder, one by an elevator, the other
by an omnibus. These wounds have long been cured,
but you can easily understand that the remembrance
of a sensation in the shoulder, that even the idea of
the shoulder, is a part of the remembrance of the acci-
dent ; it is enough that you touch one of these patients
on the shoulder for this peculiar sensation to remind
him of his accident and determine the crisis. The idea
of consumption, the fear of the phthisis, is accompanied
by a certain painful sensation in the summit of the left
lung, on the occasion of which it began. The same
sensation located in this spot will be the starting-point
of the fit. In amorous emotions, unless we have to
deal with pure spirits, there are genital sensations with
ioo The Major Symptoms of Hysteria
a swelling of the region. What difficulty is there in
understanding that in all these emotions of regret,
of love, of remorse, this image of a physical sensation
intervenes and plays the part of a starting-point ? Add
to this the innumerable associations of ideas determined
by the habits of the patient or the questions of the
physician. And do not forget that those pretended
hysterogenic points are merely spots in which certain
peculiar sensations easily arise, associated with the
remembrance of an affecting event.
Let us now pass on to the end of the fit, and you will
meet with one more essential phenomenon of somnam-
bulism: the subject, after more or less protracted
struggling, seems to wake up all at once or gradually,
sets her dress to rights, and, almost without any diffi-
culty, gets up again and resumes her occupations.
Here is to be noticed a great medical fact ; namely, that
the hysteric fit does not seem to bring about a great
physical disturbance, as the epileptic fit does. The
subject is not exhausted; she has not the stupefied,
haggard aspect of an awaking epileptic, nor the irre-
sistible need of sleep which characterizes the comitial
fit. Our hysteric patient, after howling for several
hours, feels rather comfortable; she experiences, as it
were, a relaxation, and declares she is much better than
before the fit. Another characteristic phenomenon is
that she attaches no importance to what has happened ;
she is not in the least ashamed of her cries, her indecent
attitudes, the disorder of her acts. She seems to have
forgotten everything, and in truth remembers only the
facts previous to the fit; all that has occurred after
Convulsive Attacks 101
the sensations of choking and the ascent of the ball no
longer exists for her. This oblivion is very important ;
no doubt it is more or less profound, according as the
hysteria is more or less characterized, but it is a part of
the disease. Beware of crises of violent agitation in
which there is no loss of consciousness and of which
the subject keeps an accurate remembrance. Do not
inconsiderately call that hysteria; it is nearly always
something else. In the most favourable cases, you have
to deal with the crises of agitation of the psychasthenic.
Unfortunately, you have often to deal with mental
disturbances the diagnosis of which is more or less easy.
I would only insist on the fact that our fit of real hysteria
ends with an oblivion like somnambulism itself.
Let us now return to the facts constituting the fit
itself. They are first meaningless movements. The
patients grow stiff, then seem to try still to exaggerate
this extension by throwing back the head, by raising
the abdomen, by "making a bridge," according to
the usual expression ; the head is agitated in one direc-
tion or the other, the eyes closed, or open with an ex-
pression of terror, the mouth distorted. Now the
patients grind their teeth, but without biting their
tongue ; now they open their mouth and utter piercing
cries in every tone. The arms are agitated in every
direction ; they strike at haphazard on the surrounding
objects or on the breast; the fists alternately close or
open. The breathing is loud, irregular, the heart
beats quickly, the face is congested, without, however,
being violet-hued, as in the epileptic fit. It all seems
very disorderly and unintelligible.
IO2 The Major Symptoms of Hysteria
There is, however, a comparison which at once comes
to our mind, and which is very clearly indicated in the
old work of Briquet. "A fit of simple hysteria," he
said, "is nothing but the exact repetition of the dis-
turbances by which vivid and painful moral impres-
sions are manifested.1 ... I choose as an example
what happens to a somewhat impressionable woman ex-
periencing a sudden and vivid impression. This woman
at once has constriction in the epigastrium, she feels
some difficulty in breathing; something rises to her
throat and chokes her; lastly, she feels in all her limbs
an uneasiness which causes them to fall, or she feels
an agitation, a need of movement which causes her
to contract her muscles. This is the exact model of
the most common hysteric accident, of the most usual
hysteric spasm." 2
This general conception applies very well to the
greater purt of convulsive fits. It is easy to verify the
assertion that this crisis is in fact an ensemble of emo-
tional manifestations. In many cases it is even possi-
ble to distinguish and recognize the particular emotion
thus expressed. Certain patients plainly manifest
anger; they strike, scratch, bite, and their cries are
menacing; others evidently have crises of grief and
despair, their tears and meanings have quite another
meaning than the cries of the former. It is not very
difficult to recognize erotic crises with the latter, for
they play certain scenes in a remarkable manner.
With the former, on the contrary, much oftener you
1 Briquet, "Traite de 1'hyste'rie," 1859, p. 397.
2 Id., ib., p. 4.
Convulsive Attacks 103
have crises of fear; the bewildered expression of the
eyes, the movements of defence of the arms stretched
forward, the drawing back of the body, are quite
characteristic.
Besides, nearly all these patients, though they do
not speak clearly, as in somnambulisms, mingle some
words with their cries, and you easily distinguish the
one who calls "Gaston" or "Oscar," with tender
words, and the one who howls, "Mamma, help!"
In many cases, indeed, the phenomenon may be said
to be intermediate; the subject speaks a little more,
her movements are less incoordinate and somewhat
more expressive. These phenomena are almost som-
nambulisms, analogous to the preceding ones, but less
perfect. The crisis of the woman with the dog un-
questionably belongs to this mixed type. For long
hours together the following phenomena mingle together
and succeed one another; first, sobs, tears streaming
down her face, cries of despair, great movements of
the arms to strike her breast and tear her hair, then
declamations about fate, which strikes without a rea-
son, which strikes even the best without their having
deserved their lot, then recitals of mournful passages
borrowed from such poets as Lamartine or Musset : —
Vivre un jour sans elle me semblait la mort me'me.
To live one day without her seemed to me death itself.
L'homme est un apprenti ; la douleur est son maitre.
Man is an apprentice; grief is his master.
To these phenomena, quite peculiar to somnam-
bulisms, were added somewhat different symptoms
IO4 The Major Symptoms of Hysteria
which we shall see later on, when we study the tics
of respiration; namely, certain moanings or certain
monotonous howlings which were regularly repeated
for hours together. This is decidedly a type of mixed
crisis, in which somnambulisms, exaggerated emotional
manifestations, and tics mingle together.
From all these reasons, which show us the identity
of the beginning and of the end, the analogy of the
essential manifestations, we can conclude that a great
number of attacks are nothing but aborted somnam-
bulisms; the idea, which developed itself in somnam-
bulisms through expressions of the physiognomy,
words, and acts, now only appears in the inferior and
merely emotional form, but these expressions of emo-
tion are enlarged, disfigured. They seem to have
become simpler, coarser than in the normal state.
The emotions seem to have lost their intellectual aspect
and to have increased in their visceral and motor
expressions. They appear to have fallen and become
inferior.
II
We shall reach an analogous conclusion by examin-
ing another equally frequent accident of hysterL ;
namely, fits of sleep. You know what great curiosity
this symptom has always roused. For a long time
people had been amazed at seeing individuals remain-
ing quietly asleep, in spite of all efforts to awake
them, sleeping on peacefully for hours and even days
together.
Such patients, who sleep for ten, fifteen days, some-
Fits of Sleep 105
times for months together, do not all belong to the same
variety. They differ in their physical aspect as well
as in their moral state. Some seem to have a rather
light sleep ; the subject moves from time to time, changes
his position, mutters a few words. Others have much
deeper sleep, accompanied with complete immobility,
or even with a certain degree of stiffness of the limbs.
In the last stage this sleep assumes that aspect of
lethargy which has given rise to so many superstitious
fears. As indicated by the word, the aspect of these
patients approaches that of a dead body. The face is
of waxen paleness, without any expression, the eyes
are closed, and when one opens them, one finds that
the pupils are dilated and that the eyes remain motion-
less; the skin seems to have grown cold, the visceral
functions appear to have much decreased, the breath-
ing is superficial and rare, the beats of the heart are
hollow and difficult to perceive. It appears that a
certain number of patients in this state have been mis-
taken for corpses and that this accident has given rise
to untimely interments. For my part, I am always
surprised when I hear of such mistakes. None of
the lethargic people I have had the opportunity of
seeing could, in my opinion, be the object of any illu-
sion; a little attention was sufficient to avoid this
absurd mistake. First of all it is not true, at least in the
rather numerous cases I have seen, that the functions
stop ; one cannot feel the pulse, but, with some atten-
tion, one can always hear the heart ; if one seeks well,
one always finds some manifestations of the breathing.
Besides, the temperature is not very low, and the skin
io6 The Major Symptoms of Hysteria
never gives by its contact the impression of a cadaveric
skin. There are even some little peculiar phenomena
that seldom fail ; for instance, that slight tremulousness
of the eyelids which is typical, the pupillary reflex
either to light or, oftener still, to pain, the change of
attitude if the mouth and nose are closed and the breath-
ing hindered. In a word, I do not very well under-
stand how one can mistake a hysteric patient in lethargy
for a dead woman, and in my opinion such mistakes
imply great ignorance. It is necessary, however, to
warn you against this danger.
As I told you at the beginning, I do not think that
all hysteric fits of sleep are of the same kind, any more,
indeed, than are all attacks. We shall resume this
question when we have studied certain disturbances of
the visceral functions of hystericals. To-day I wish only
to make you understand one of the most frequent forms
of these sleeps, the one which, it must be acknowledged,
usually seems to be the least profound and serious. It
is to be found with those subjects who fall asleep for
a few hours and who nearly keep the aspect of normal
sleep.
I do not think that in these individuals the psycho-
logical phenomena have disappeared; I do not think
that their sleep is a merely physical phenomenon. By
many methods one can prove the existence of thoughts
that continue to develop in their minds. First of all,
a protracted and attentive observation very often shows
you slight signs connected with thoughts. There are a
few little movements of the lips, as if the subject wanted
to speak, or sometimes smile, a few little transient ex-
Fits of Sleep 107
pressions of the physiognomy, a few little movements
of the hands. In certain cases, you have quite the im-
pression that the patient chatters inwardly, and that but
little is wanting for you to be able to understand him.
By means of certain processes which we cannot study
in detail, one can sometimes put one's self in relation
with such subjects ; by merely touching them, speaking
to them, it is possible to attract their attention, and then
one can question them and obtain certain answers.
Sometimes, in the most favourable cases, the subject
will answer by speaking ; sometimes he will answer by
slight signs of the fingers or face. If you take his hand
and ask him to press it in order to say "yes," some-
times you obtain nothing but movements of the eyelids
and eyebrows: a slight lowering of the eyebrows will
mean "yes," their rising will mean "no." And you
can thus penetrate a little into his thought. Lastly,
in other and more frequent cases, you will be able, after
the crisis of sleep, to find again the recollection of it in
states of artificially provoked somnambulism, about
which I shall tell you a few words at the end of this
lesson.
By using these various means, you can ascertain that
the immobility of such patients is much less physical
than moral. Some have in their mind the fixed idea of
sleep or death, and they realize outwardly the attitude
they are thinking of. But many others have ideas that
are not in the least connected with the sleep. They
are seized with a profound revery, in which they contem-
plate scenes that present themselves before them, or
indulge in an endless inward chattering. A girl of six-
io8 The Major Symptoms of Hysteria
teen, who has been terrified by a bull coming to attack
her, has crises of sleep, with perfect immobility, during
which she is appalled by the hallucination of the bull.
Another, aged thirty-two, in despair at the death of a
friend, relates to herself dismal stories about her own
death: "They are going to put candles near my bed;
they are putting me in a little deal coffin ; my friends are
bringing white flowers to put on my little coffin, which
is there, placed on two chairs — " and she talks thus
endlessly. A man of twenty-five has been much upset
by an accusation brought against him by a fellow- work-
man. When he meets with this individual, he becomes
motionless, like one petrified, and at last he slips to
the ground and lies, as if asleep, for hours together,
talking inwardly about the accusation brought against
him. He fancies he is before his employer, and defends
himself in every way, arguing in a complicated manner
as if he were before a court of justice.
It is useless to remind you of the fact that we could
make concerning these sleeps all the remarks we have
made about the beginning and the end of the fits.
They are likewise originated by an affecting event, and
the same part is played by the provocative circumstances,
which, by an association of ideas, recall the initial event.
You have just seen an example in which sleep is provoked
by the sight of the person who brought the accusation.
We could resume the same discussion about certain
special points which have been called hypnogenic points.
In my opinion, these points do not act at all for physical,
but for moral reasons, because the sensations they bring
about are associated with the affecting idea. At the
Fits of Sleep 109
end of these fits of sleep, there occurs the same awaken-
ing with indifference, and especially the same oblivion,
exactly as in somnambulisms.
You see, therefore, that these new phenomena do
not differ very much from the preceding ones. How-
ever, you remember that, in somnambulisms, there
were intelligible words, complex acts, and expressive
movements; in attacks, the words and acts had dis-
appeared; in the fits of sleep, which we are now
considering, there remain not even movements or con-
vulsions. It seems, therefore, that all the phenomena
of somnambulism have disappeared.
But these missing phenomena are not, in my opinion,
essential phenomena. What was most important in
somnambulism was, as I told you, an idea persist-
ing in consciousness and developing to an exaggerated
degree. The development is complete if it manifests
itself by emotional expressions, by words and acts;
it is much less complete if nothing remains but the first
term; namely, the emotional agitation; yet the idea
may still persist and pervade immeasurably the con-
sciousness of the patient, without manifesting itself
by anything outwardly. The subject is then invaded
by a kind of meditation from which nothing can dis-
tract him; he perceives no phenomenon foreign to his
dream, and this is the reason why he cannot be awakened
by any means whatever, and takes on the appearance of
being in a profound sleep. So we were right in saying
that this form of hysteric accident was also connected
with somnambulism, of which it was only the last
degree.
no The Major Symptoms of Hysteria
III
I should not like to conclude this study of hysteric
somnambulisms without indicating to you in its proper
place, if not a new form, at least an important char-
acteristic of all the preceding forms. A very curious
property of hysteric accidents, which, no doubt, is not
absolutely peculiar to them, but which, carried to this
degree, is rare, is that they can be artificially re-
produced.
In most diseases, the accidents are not at our disposal.
To take only one striking example, we are not at all
masters of an epileptic fit; we cannot stop it at will,
nor can we reproduce it, or make it reappear when we
please. Let us take, for example, an individual who
has been affected with epilepsy for ten or twenty years,
and who very frequently has the most decided epileptic
fits. Well, if we wished, for any reason, in the interest
of the patient himself, to study his epileptic fit, if we
wished that a fit might take place in our presence in
the laboratory, where we have the time and the means
to examine its details accurately, we could not, as you
know, realize this wish. We can take the patient before
us, try him in every way, but he will present no patho-
logic phenomenon. He will not be impressionable at
all, he will not have the shadow of an epileptic fit. An
hour afterwards, when we are gone, and without our
knowing why, he will suddenly fall and have a great epi-
leptic fit. It is a disease on which experimentation has
no hold. Formerly it was so with three-fourths of the
Artificial Somnambulisms 1 1 1
diseases; nowadays, owing to the discoveries of physi-
ology, of microbiology, and sometimes of psychology, we
begin to be able to reproduce in the laboratory some of
the diseases we want to study. You know that it was
a revolution when Pasteur demonstrated that the cattle
plague, — the carbuncle, — could be given to an animal
when one pleased. It is the beginning of medical
science, and sometimes of therapeutics, to be able thus
to bring about the outbreak of a disease at will.
Well, this character is developed to the highest degree
in hysteric neuroses, and it applies especially to the
somnambulisms of which I have just spoken. Notice
first that it is a constant symptom of monoideic som-
nambulisms. We have only to awaken in a more or
less precise manner in the mind of the subject the idea
whose development fills up the somnambulism, to cause
the latter to reappear. Sometimes, to awaken such an
idea, it is necessary to recall it completely, to describe
it, to dwell on the images that constitute it ; sometimes
it is sufficient to make a sign, to call up a term asso-
ciated with that idea, for the rest of the somnambulism
to develop, owing to the automatic association which
you know. Speak of Pauline to that young wpman
who wanted to imitate her by throwing herself out of
the window ; she will think of the suicide of her niece,
go towards the window and begin all the scene over
again. Question Irene on the death of her mother;
you will see one of the following different phenomena :
either, as we have noted, she understands the question,
only partially answers us vaguely, has no accurate
remembrances relating to her mother's death, nor even
\i1 The Major Symptoms of Hysteria
to her illness ; or, if you insist a great deal, if you remind
her of facts characteristic of the agony, the subject will
lose her composure, be agitated, and cease to hear us
or see surrounding objects. She will soon be absorbed
in her dream, and then will recite in a declamatory
torie the details of the agony we spoke of, and begin to
play the scene of the death and of her own attempt
at suicide under an engine; the somnambulism has
begun again.
What we have just said applies to all the other forms
of somnambulism; to polyideic somnambulism, in
which the dream, when once begun, is transformed
by the appearance of new circumstances; to fugues
themselves, which we can make the patients recommence
by dwelling on the dominant idea. Many of the fugues
of young R. were in some manner experimental;
his comrades provoked them by recalling through their
chatter the stories of travels which had impressed the
patient. Nay, more, — the fact is but little known, —
double existences can be experimentally reproduced.
Allow me to recall this remarkable observation on
which I have often insisted already, that of Marceline,
whom we have just studied in our preceding lecture.
This patient, as you know, was transformed by hypno-
tism and kept during fifteen years two existences, the
former with depression, anesthesias, amnesias, anorexy,
etc., brought about by the hysteria ; and the latter with
rather good health, normal sensations, and memory de-
termined by artificial excitation. She had really become
a kind of artificial Felida, and she shows us that double
existence itself can be reproduced by artificial means.
.
Artificial Somnambulisms 113
What I have just told you of somnambulisms is still
truer with respect to those incomplete forms of somnam-
bulism which we have just studied under the name of
emotional fits and fits of sleep with revery. Those who
described the hysterogenic and hypnogenic points had
insisted on the following character; namely, that at
any moment you could, by the excitation of these points,
cause the patient to fall back into the attack or sleep.
One fell into convulsions as soon as her lower abdomen
was pressed, the other into a fit of sleep when one of
her breasts was touched. We know now what these
phenomena mean ; they belong to the same group with
the preceding ones. The sensation provoked is again
a signal associated with the group of psychological
phenomena of the crisis. I shall only recall the essen-
tial fact ; namely, that we can make these phenomena
reappear artificially.
The states thus artificially reproduced, the somnam-
bulisms especially, are not long in being a little modi-
fied. After a certain time, they are no longer quite
identical with the original, natural phenomena. The
reason of this is, as we saw when we studied polyideic
somnambulisms, that new ideas may develop in this
state without stopping it. An idea that plays a great
part is the idea of the experimenter who has artificially
provoked the state. The latter is more and more ca-
pable of introducing himself into the somnambulism
of the subject. At first he can only be understood by the
subject if he speaks to her of ideas related to the som-
nambulic dream, but he is soon himself a part of the
dream and is heard and understood if he speaks of any-
114 The Major Symptoms of Hysteria
thing whatever. The greater and greater influence the
experimenter acquires over his subject is not long in trans-
forming the somnambulism, in giving it a form and laws
that are often strange and simply result from the habits
of the experimenter. One teaches his subject always to
to say "thee, thou," during the somnambulic state,
whereas she says "you" in the normal state; another
accustoms her to fall profoundly asleep when her eyes
are touched, and to wake up when her vertex is touched.
Such phenomena were formerly presented as laws of
somnambulism, and gave rise, at the time of Charcot,
to many passionate discussions. Thus is formed in
some subjects an artificial somnambulism, which has
been given the name of hypnotism.
This hypnotism raises one last serious question,
which we cannot treat in detail, and on which I con-
fine myself to giving you my personal opinion. Is this
hypnotism something distinct from hysteric somnam-
bulism? Is it something peculiar, an abnormal state
independent of hysteria? You remember what great
battles have been fought on that point. For my part,
I do not hesitate, and these are the principal reasons
for my opinion : first, considered in itself, the hypnotic
state has never any character which cannot be found
in natural hysteric somnambulisms. The modifica-
tions it offers are very easily explained as the result of
education.
Secondly, if you examine the subjects with whom
this state can be obtained, you will be convinced that
they are mostly hysteric patients, having already had som-
nambulism in some form or other, or for the remaining
Artificial Somnambulisms 115
part hysteric patients having presented other acci-
dents, but having the mental state characteristic of
hysteria.
Thirdly, you can verify, if you examine matters with-
out preconceived ideas, the fact that subjects troubled
with other diseases than hysteria — epileptics, for in-
stance, psychasthenics tormented by the mania of doubt,
lunatics affected with systematic delirium — are not at
all hypnotizable, and that one will never be able to
reproduce in them a real somnambulic state with com-
plete consecutive amnesia.
Fourthly, and I find this remark very important;
this artificial somnambulism is healed and disappears
in the same manner as natural somnambulisms. A
subject whose hysteria decreases, who tends towards
recovery, whose mental state changes, ceases to be hyp-
notizable.
Fifthly, and lastly, these two states are so analogous
to each other that you can pass from the one to the
other by imperceptible transitions. You can enter
into relation with an individual in natural somnambulism,
first speak to him of his dream, get him to listen to you,
then direct his thoughts and afterwards put him into
the hypnotic state at will. Inversely, the hypnotic state,
if you do not sufficiently direct the mind of the subject,
can be transformed into a state of ' independent dream,
into a state of hysterical somnambulism.
In a word, it seems there is no reason for making a
special place for the hypnotic state; it is a somnam-
bulism analogous to the preceding one, and differs from
it only in that it is obtained artificially instead of devel-
n6 The Major Symptoms of Hysteria
oping spontaneously. So we have passed in review
the different forms of somnambulic accidents that
characterize hysteria and constitute more than half
of the accidents of this neurosis.
LECTURE VI
MOTOR AGITATIONS — CONTRACTURES
Disturbances in the motor functions of the limbs — Apparent
exaggeration of motion — The phenomenon of tics —
Rhythmical choreas — The absence of will, of consciousness,
anesthesia — The diagnosis — The tremors — The con-
tractures — Clinical importance of this accident — The
part played by mental phenomena — The degradation of
the movements in these hysterical accidents
HYSTERIC neuroses, the history of which we are pur-
suing, very often present accidents of quite another
nature, which at first sight seem to be different from
somnambulisms. These accidents do not affect the
whole of the body and of the mind, like the former ; they
seem only to disturb certain functions, and, in particu-
lar, the accidents we consider to-day appear only to
disturb the motor functions of the limbs. In spite of
the disturbances seated in the arm or leg, the mind
may appear, at least in certain cases, absolutely intact,
while in somnambulisms the delirium seemed to
be general. In the second place, motor disturbances,
which we now consider, are not momentary, but they
are lasting. Instead of appearing, like attacks and
somnambulisms, at determinate moments, and dis-
appearing in the interval, they may last for a long time,
for days and months together, no matter what the state
of the subject may be. They may exist during the fits
117
Ii8 The Major Symptoms of Hysteria
and also exist in the interval. So you see that the phe-
nomena are apparently pretty different.
Yet most physicians, especially since the end of the
last century, do not hesitate to connect this ensemble
of motor disturbances with the same neurosis, with
hysteria. Perhaps we shall be able to justify this diag-
nosis later on by showing that the mental disturbance
is at bottom about the same as in somnambulisms.
For the present, we cannot ground our argumentation
on this still unknown character, and we are obliged
to justify the diagnosis of these disturbances of motion
by mere clinical remarks. We observe only that they
present themselves in the same subjects and in the same
conditions as the preceding somnambulisms. The
patients we shall describe to you to-day who have had
these perversions of motion, these agitations or paraly-
ses, are the same whom we already know; they had,
a short time before, monoideic somnambulisms, fugues,
or fits. They can still, if we choose, enter into those
hypnotic states which we consider as the reproduction
of spontaneous somnambulisms. In them, these various
accidents alternate with one another. After a fit they
may have spasms or paralysis; inversely, these dis-
turbances of motion may disappear in a new fit or a
new somnambulism. No doubt, these are not abso-
lutely irrefutable reasons, and it will be necessary to
complete the diagnosis when we know better the nature
of these motor phenomena ; but after all, these reasons
are sufficient to induce us, while pursuing the study of
the hysteric, to enter into the examination of these
phenomena which these patients often present.
Motor Agitations — Contractures 119
The motor disturbances that have the preceding
characteristic are very various and irregular; we
could range them in two large groups : first, phenomena
of at least apparent exaggeration of motion, which seem
to exceed the will of the patient and to develop inop-
portunely and without his consent, and second, phe-
nomena of deficiency, in which, on the contrary, motion
seems to fail and not to obey the will and consciousness
of the subject. In the first group, which we designate
under the general name of motor agitations, are to be
ranged tics, choreas, and contractures ; in the second,
the strange functional paralyses, or paralyses dependent
on ideas ; to-day we shall study only the first group.
You all know the commonplace phenomenon of
tics, which is to be met under so many circumstances;
I advise you to keep the French word because I do
not find in the English language a good translation.
You must not fancy that all tics are hysteric. There
are some epileptic tics, and even oftener, psychasthenic
tics, but, to confine ourselves to our preceding diagnosis,
there are some tics that are to be met with in patients
who have already had all the preceding forms of som-
nambulism, and that alternate with these somnam-
bulisms.
These tics are essentially constituted by little move-
ments of the face, head or limbs, which appear at
random, without any relation either to the present cir-
cumstances or the consciousness of the patients. This
I2O The Major Symptoms of Hysteria
name is generally reserved for rather sudden little move-
ments of short duration, and other terms are used when
the same involuntary movements have a greater extent.
These little muscular shakes may present themselves
in all parts of the body. You may especially notice
them in the face; they constitute grimaces of a thou-
sand kinds, affecting the eyes, the nose, the mouth.
The patient puckers his forehead in various ways,
raises or lowers his eyebrows, winks, looks sideways
by starts ; he makes his nostrils tremble, closes or opens
them too much. A very interesting patient, whom
we shall study with more detail to-day, blows violently
through his left nostril. Others seem to wipe their
noses or to sneeze ; their lips suddenly draw to the one
side or the other, stretch forward or shrink backward, or
else are continually bitten — the upper lip as well as
the lower one. The tics of the neck have been brought
into notice by being described under the name of
psychic stiff neck; involuntarily and suddenly the
patient inclines his head towards one shoulder, or throws
it back, or bends it forward, or turns it on its axis. He
repeats these movements every two or three seconds in
a way which it is impossible to explain or justify by
any present reason.
I do not speak now of the tics related to the visceral
functions such as the alimentation or breathing tics;
I at once pass on to the tics of the limbs. In these
the arms, the hands, seem to have taken strange habits ;
they rise suddenly or move backwards; the shoulders
are shaken convulsively; the legs, instead of regularly
performing the act of walking, every moment interrupt
Motor Agitations — Contractures 121
it by a strange little shake of the knee or foot or toes.
These little movements, which have innumerable forms,
of course impede every action of the arms, and when
they occur in the waking state, they often make walking
almost impossible.
Let us proceed at once, in order not to interrupt the
description, to the same kind of involuntary and use-
less movements that have a greater extent and, for
that reason, have been called choreas. This distinc-
tion is not essential at the bottom, and must not pre-
vent us from putting all the motor agitations in the
same group. The first choreas that physicians decidedly
connected with hysteria were the rhythmical choreas,
thus called because the movements were repeated
regularly at determinate intervals, like those of a pen-
dulum. This kind of rhythmical movements occurs
very often in the hysteric fit ; it constitutes those com-
plications of the simple fit which I have pointed out
to you. Very often the patients, without recovering
consciousness, cease their emotional manifestations
to indulge in some odd and perfectly regular gymnas-
tics.
One of the most commonplace is the salute, which
Charcot described; the patient, lying on her bed, sits
up, bends her head and body forward, sometimes low
enough to touch her knees, as if she were making a
salute, then suddenly throws herself back till her head
falls on her bed. After a moment, she begins again;
she may thus make this salute twenty or forty times a
minute for hours together. Others have malleatory
movements of the arm or leg; you would think they
122 The Major Symptoms of Hysteria
strike regularly with a hammer. Others again have
saltatory movements ; either when lying or when stand-
ing, they appear to jump or dance regularly. Besides
these definite classified movements, there are hundreds
of others which have no definite name ; this one clinches
her fists and suddenly brings them together towards
the middle of her body, then separates them, and be-
gins again indefinitely; another turns her right wrist
as if it were fixed to a wheel, and so forth indefinitely.
In all such acts there is always the same rhythmical
regularity; Charcot quoted, in reference to this, the
sentence in Hamlet : " Though this be madness, yet
there's method in it," and wished a ballet-master might
observe and write down the strange and regular move-
ments of the patients.
These movements have their maximum of strength
and rhythmical regularity during the fit; but it is
characteristic of the motor agitations we speak of, that
they may very well persist in the interval of the fits.
The patient speaks correctly ; he is in possession of the
whole of his consciousness, has all his recollections,
can even execute movements with his unharmed limbs,
but he continues to make the rotary movement with
his right hand and bring his two hands into contact
or separate them.
Though the more distinct hysteric chorea is thus
characterized by a rhythm, you must not fancy that
every other chorea in which there is no rhythm is neces-
sarily outside the great neurosis; that was believed
formerly, but this too simple diagnosis had to be re-
formed. No doubt, a very irregular chorea, consist-
Motor Agitations — Contractures 123
ing in characterless shakes of the arms and legs occur-
ring without any kind of regularity amidst voluntary
movements, is usually the common chorea, called
chorea of Sydenham, with which we have not to deal.
If, however, such a chorea appears in adults or young
people after their puberty, you must be on your guard,
for such choreas, though arrhythmic, may very well
depend on hysteria. A young woman thirty-one years
old, terrified by an explosion in a factory where she
worked, presented for more than ten years, deliriums,
fits, somnambulisms of all kinds which were unques-
tionably hysteric. Amidst these various accidents,
taking their place or alternating with them, she had
very long periods of chorea. This, chorea of all the
limbs and of the head presented no kind of rhythm,
and yet we do not hesitate to maintain that it was a
hysteric phenomenon like the other accidents of the
patient. We have noted about twenty quite typical
observations of this kind, which clearly show that the
arrhythmic chorea must be counted among the possible
forms of hysteric motor agitation. Its diagnosis then
depends not only on the previous and simultaneous
accidents, but also on the mental state which accom-
panies it, and on which we must now insist.
II
Whatever may be the tics or choreic movements
that these patients present, you observe a certain number
of psychological characteristics accompanying them,
which characteristics are the easier to discern as these
124 The Major Symptoms of Hysteria
motor accidents continue during the waking state and
it is possible to question the subject about what he feels.
When the movement thus exists during the waking
state, one can better realize the mental state that ac-
companies it.
First of all the will of the subject has no influence
on it. Of course, the subject asserts that he does not
want at all to make this movement, and by all his
conduct shows us that he would very much like to be
rid of it, but he cannot stop it any more than he can
produce it. The efforts of his will appear powerless;
by making great efforts he can at most disturb the
rhythmical movement, make it less regular, complicate
it with shakes of the rest of his body. The movement
is not stopped, and begins again more regularly when
the subject gives up his efforts of will.
Consciousness does not seem to have a great hold on
this phenomenon either ; the subject seems to be scarcely
aware of his tic or his chorea ; very often he performs
it without knowing it; even when he is attentive, he
feels it but little or even not at all; when he shuts
his eyes, he may very well declare that now his arm
no longer moves at all, while the movement continues
with perfect regularity.
We see those phenomena of insensibility appear here,
which will play a greater and greater part in hysteric
accidents. When treating of somnambulism, we spoke
but little of insensibility; in the first place, when the
somnambulism is at an end, this disturbance may fail
entirely; a somnambulist is not necessarily insensible
in the waking state ; he is merely amnesic ; it is amnesia
Motor Agitations — Contractures 125
that is the stigma of somnambulism, and not anesthesia.
Then during the somnambulism itself, there is, it is
true, a certain anesthesia, but it is very peculiar, and
only affects the phenomena which are not connected
with the subject's dreams. When we come to motor dis-
turbances, that insensibility which is called hysteric
anesthesia begins to intervene. It may present itself
in two ways ; sometimes it is systematic and bears only
on the movement that constitutes the tic or the chorea.
The subject does not feel that he moves his forehead,
or that he strikes his bed regularly with his hand, but
he feels the other things, and in particular, is able to
tell you that somebody seizes his hand while he is
performing the choreic movement. Notice this sys-
tematic anesthesia, which will become more and more
important. Sometimes the anesthesia is more impor-
tant, and the whole of the limbs affected with a tic
or a chorea is insensible. For instance, one of the sub-
jects to whom I alluded used to turn his right hand in
a circle and had a see-saw movement in his right foot ;
the whole of his right side was nearly insensible.
These anesthesias, this kind of unconsciousness,
must play a certain part in the diagnosis ; you will not
meet again with the same characteristics in the same
degree in tics of another nature, particularly in the tics
of the psychasthenic. With the latter, the tic, while
appearing involuntary, is accompanied by a great deal
of consciousness and attention. The subject performs
his tic when he thinks of it, when he directs his atten-
tion to the organ and tries to keep it motionless. It
seems that, with these patients, attention increases the
126 The Major Symptoms of Hysteria
tic instead of diminishing it. Inversely, you may ob-
serve that distraction sometimes has a good effect.
When the subject forgets his disease and his mind is
absorbed by something else, he leaves off performing
his tic. You see that with him the tic is conscious, that
it is in connection with thoughts the subject possesses.
There is, therefore, no anesthesia in this case. The
subject feels his movement very well and all that passes
in the diseased limb. With the hysteric, the move-
ment is impeded by attention; it develops, becomes
more complete and regular in a state of distraction; it
is much oftener accompanied with anesthesia.
These characteristics, which serve to make the diagno-
sis, also enable us better to understand the nature of the
phenomenon. In fact, the tic and the choreic movement
are much more intellectual phenomena than they
appear to be. We notice many mental phenomena
at their beginning exactly as at the beginning of som-
nambulisms. One has had an accident to his face or
eye, another a pain in his teeth ; the man who constantly
blew through one of his nostrils had had for a long time
a scab in his nose, consequent upon a bleeding at the
nose. All the patients who have had mental stiff necks
had had some moral impression relating to a movement
of the head. A girl I am attending now felt very dull
at home; she worked all day long by a window that
looked out into the street. Her strongest desire was to
leave her monotonous work and go out into the street
at which she constantly looked. At every moment
she lifted her eyes from her work and turned her head
to the left in order to see what was going on in the
Motor Agitations — Contractures 127
street. She gradually felt that her head constantly
turned to the left, and even maintained that her hat
was too heavy on that side. An absurd diagnosis, the
application of a plaster bandage, had singularly ag-
gravated her state, and now she has a bad mental stiff
neck on her right side.
These ideas, these more or less definite mental phe-
nomena which existed at the beginning, persist through-
out the development of the tic or the chorea. Let us
return to a singular story, which I have often related.
It tells how the rhythmic chorea of that girl of sixteen
had begun, who kept on turning her right wrist and
regularly raising and lowering her right foot. One
evening, on the eve of the quarter-day, she had heard
her parents, who were poor work-people, bewailing
their poverty and the difficulty they had in paying their
landlord. She was very much moved, and from that
time she had at night a kind of somnambulism, during
which she tumbled and tossed in her bed and repeated
aloud: "I must work, I must work." Now, what
was the work of this girl? She had a singular trade,
which was to make dolls' eyes, and, for this purpose,
she worked a lathe by treading a pedal with her foot
and turning a fly-wheel with her right hand. During
her nocturnal somnambulism, she made this movement
of the hand and of the foot, but this movement was
evidently accompanied with a corresponding state of
consciousness, since she repeated aloud: "I must
work." It was a simple somnambulic action, like all
those we have studied. On awaking, she no longer has
any recollection or consciousness of her dream, but the
128 The Major Symptoms of Hysteria
movement continues exactly the same on her right side.
Is it not likely that it is still accompanied with a state
of consciousness of the same kind ?
We can make this state of consciousness evident by
certain experiments which we know now how to effect.
By hypnotizing the subjects, you find again dreams
that account very well for the continuation of the tic.
For instance, a young woman comes to complain of
a pretended vertigo ; it appears that, in the street, every
hundred steps, she feels herself as it were precipitated
forward, that she suddenly takes a leap and has often
fallen while taking it. What a strange vertigo ! In
a state of induced somnambulism she relates to us what
follows: Once she went to her parents, who sharply
reproached her for her irregular conduct. On going
out of their house, she took a resolution that simplifies
many things, — she made up her mind to commit
suicide, and in a dream, of course, for she was,
happily for her, hysteric to a high degree — she fancied
she had got upon the parapet on the bank of the Seine,
took a leap, and was awakened by a fall to the ground.
In all such cases, the existence of a system of images
that works unknown to the subject is undeniable.
The difficulty is greater in the case of great uncoor-
dinated choreas, in which all the motor functions seem
to take a part. It is no longer merely a special thought,
a system of images that seems to develop outside of
consciousness, it is a function in its entirety, the func-
tion of moving the arm or leg, that seems to emancipate
itself. Let us notice for the present this phenomenon,
which appears to us for the first time; it will become
clearer and clearer through new studies.
Motor Agitations — Contractures 129
m
Indeed, the problem raised by such dissociated motor
activities working separately, outside of consciousness,
becomes singularly complicated when we examine
other forms they may assume, which are among the
most important phenomena of hysteria. I refer to
tremors and contractures.
In a very great number of cases, hystericals have
other disturbances of motility than tics and choreas.
Their limbs are affected with a strange agitation differ-
ing from the preceding ones; for example, they are
seized with tremors ; the arm has regular little oscilla-
tions, of an average rate of five to nine a second. These
oscillations are nearly continual. There are some
subjects with whom they never stop, either when they
rest or when they move; there are some others with
whom these tremors are intermittent, disappearing at
the time of voluntary activity and increasing at the
time of diversion and rest. But it is not possible to
establish any rule, for you often observe the reverse
in the form of intentional trembling, analogous to that
of disseminated sclerosis; the subject, almost motion-
less when at rest, begins to tremble when he seeks to
perform a movement (Figure 7).
These tremors occur under various conditions,
sometimes gradually, after paralytic phenomena, very
often suddenly, after an emotion. One of the finest
cases I have observed is that of a workman, who, in
consequence of the breaking of a scaffolding, remained
Motor Agitations — Contractures 131
suspended at the height of a sixth floor. Others
began to tremble after a fright, after receiving bad
news. In one of my observations, the tremor which
began in the right arm was consequent on a dream.
The subject fancied he was pushing back an assassin
with his right arm.
In some rare cases, you can find behind the tremors,
as behind the tics, the existence of a fixed idea separated
from consciousness. A woman who presented an in-
tense tremor of the right hand at last confessed that this
tremor had appeared in consequence of her having
long practised automatic writing in order to question
spirits. It was enough to put a pencil in her right hand
for the tremor to cease and to be transformed into
writing.1 So we had certainly to deal with a kind of
tic, with an incomplete subconscious action which
assumed the appearance of a tremor.
But, in most cases, there is nothing behind the tremor
but a vague emotive state and a kind of transformation
of the motor function of the limb.
It is what we observe in a higher degree in the
exceedingly serious phenomenon of hysteric con-
tractures. You know that the history of this phe-
nomenon may be said to begin with the lessons
of Brodie, 1837, "Lectures Illustrative of Certain
Local Nervous Affections"; then we have the works
of Coulson, 1851, of Paget, 1877, of Charcot, of Lasegue,
of Paul Richer. This history corresponds to the evo-
lution of the greatest problems of medicine, for physi-
cians have been led gradually to separate the hysteric
1 See " Ne"vroses et Id6es fixes," II, Observation 95, p. 332.
132 The Major Symptoms of Hysteria
contractures from all the osseous, articular, medullary,
and nervous affections with which they were formerly
confounded. It amounts to saying that this problem
is connected with everything in medicine.
This contracture is a state of moderate contraction of
an ensemble of muscles which maintains a limb in a
determinate position, and that in an involuntary, un-
conscious, and indefinite manner. Such contractures
can be observed on absolutely all the muscles of the
body, and in each region ; they raise medical problems
which I can only point out to you. In the eyes, they
determine the spasm of the orbicularis and the occlu-
sion of the eyelids ; at the mouth, they are located very
often on only one side, and they bring on the distortion
of the face. In both cases, they must be carefully dis-
tinguished from paralytic phenomena, which they simu-
late ; from the ptosis of the eyelids, which fall passively
instead of contracting; and from the paralysis of one
side of the face, which equally causes the face to deviate
to the opposite side. You know the importance of the
ptosis of the eyelids and of the unilateral paralysis of
the face; the diagnosis is of capital importance. The
contracture may be seated in the neck, back, abdomen,
or thorax, and in each place new problems arise. Here
it simulates diseases of the vertebrae, deviations of the
vertebral column; here it transforms the breathing
and causes you to believe there is a pulmonary disease.
In other cases it assumes the appearance of all possible
tumours of the abdomen. It is these contractures which
originate the great medical errors of which hysteria is
the occasion. As regards the limbs, we have the con-
Motor Agitations — Contractures 133
tractures of the legs, of the hip, with the important
problem of the white tumour of the knee and of tubercu-
lous coxalgy. I think the most expert physician ought
never to boast that he will make no mistake when he
has to decide between hysteric coxalgy and tuberculous
coxalgy. As regards the arms, the difficulty is not so
serious in general ; yet you must beware of false luxa-
tions of the shoulder, of arthrites, and of cysts of the
elbow or wrist. There is not a more important clinical
problem than that of contractures.
Curiously enough, we also meet here with an im-
portant psychological problem, with a question that is
certainly one of the most obscure of pathological psy-
chology. It is obvious that a certain number of the
phenomena connected with these contractures are very
clear; first we know that contractures are consequent,
like all hysteric phenomena, on thoughts and emotional
phenomena. A shock has no action in this direction
except when it determines great phenomena of imagina-
tion. I will explain myself : An individual has his legs
in a state of contracture because, he says, a carriage
ran over them. After verification, it is found that the
carriage passed beside him, and that he felt nothing at
all. A real shock would do less than this imaginary
shock.
According to all the observations that have been
made, the production of a contracture requires, exactly
as does that of a somnambulism, some emotion, some
fear for the future, some terror, some dream, etc. It
is the same with the cure of these contractures ; in cer-
tain cases they persist indefinitely. I have two cases
134 The Major Symptoms of Hysteria
which lasted for thirty years. In other cases, they are
suddenly cured through influences that are incompre-
hensible if one does not take into account imagination
and emotion. These diseases are among those which
make the fortune of religious relics and miraculous
springs. When you hear a story about a cripple with
hard shrivelled legs, twisted under his body, who was
rolled to the spring in a low carriage, and got up again,
bearing away his carriage on his shoulders, you need not
have the least hesitation in pronouncing the case one of
hysteric contractures. If you are fond of erudition, I
recommend you to read the admirable book of Carr£
de Montgeron on the miracles wrought in the cemetery
of Saint Medard on the tomb of Deacon Paris, 1737.
It is also phenomena of this kind that physicians
have cured in determinate conditions by all sorts of
processes, by the electric current, by magnets, by the
application of metallic plates, by merely speaking to
the patients. So there are a great many psychological
phenomena as well at the end as at the beginning of
contractures.
You also meet with some during the time the phe-
nomenon itself lasts. First of all, the contracture is
more frequently systematic, at least at its beginning,
than is generally believed. The limb is not stiff in
every position; depending on the unequal strength of
the different muscles, it keeps a particular attitude re-
quiring a certain harmony of permanent contractions.
A woman has seen in the hospital an individual who
had died of tetanus; she reproduces his attitude, and
keeps her head thrown back. Another, of whom I have
Motor Agitations — Contractures 135
often spoken, constantly keeps both her feet extended in
the position of Christ on the Cross ; she has, moreover,
a religious delirium in which she thinks herself crucified.
She has crises of somnambulism and catalepsy in which
her trunk, arms, and head remain, for hours together,
absolutely in the attitude they must have in a crucified
person.1 During these crises the entire attitude decidedly
corresponds to a delirium and to thoughts. When, in
the interval of the crises, the feet alone keep the con-
tracture, it is very likely that something of the delirium
persists.
From another point of view we may notice that the
contracture varies with certain psychological facts. If
the subject is very quiet, if nobody touches her con-
tractured limb, and if she herself does not try to make
a voluntary movement, we may see that the contracture
decreases and that the limb unbends. Lastly we may
observe in contractures many forms of insensibility;
the subject does not feel the fatigue of this permanent
contracture, very often she does not feel anything at all
in her contractured limb. In a word, you see that we
may notice in contractures a great number of facts
analogous to those we have observed in tics and
choreas, showing us a kind of abnormal functioning of
a psychological system which in some way or other has
become independent.
I must however add that we meet here with a new
difficulty, the germ of which, indeed, was already to be
found in choreas and tremors. Let us try, with our
1 " Une extatique," Bulletin de I'lnstitut psychologique interna-
tional, 1901, p. 209.
136 The Major Symptoms of Hysteria
sound limbs, to copy the attitude of a rhythmic chorea
and register our movements accurately. You will find
that you are much more awkward than a hysteric per-
son, and that, unless you have practised specially to
this end, you cannot obtain the same regularity. Try
to keep your arm in the position of a hysteric contrac-
ture and describe the movement of the arm; you will
remark that you have not the same perseverance or
courage as the patient. After a short time, your arm
trembles and is displaced, while the hysteric contrac-
ture has not changed. If therefore we suppose there is
a psychic action in these hysteric phenomena, it must
be acknowledged that this action is not identical with
ours, but that it is performed in other conditions.
Here is my hypothesis ; think of it what you please ;
the actions that are manifested by muscular movements
present different degrees of perfection corresponding to
the development and systematization of the conscious-
ness that accompanies them. These degrees of per-
fection are manifested first of all by psychological char-
acteristics of the action, delicacy, harmony, usefulness
of the act, but it is also manifested by properties of the
movements themselves. The muscular movement of a
draughtsman's hand is not the same as the muscular
movement of a dog's or a crocodile's paw. There are
some particular physiological properties accompanying
the perfection of the act. Some are known: the
rapidity of the contraction is much greater, and in
particular the rapidity of the decontraction, of the fall
of the muscle, is much more considerable. In the
muscles of the lower animals, the contraction takes
Motor Agitations — Contractures 137
place slowly and disappears slowly. We see also the
same modifications of the muscular contraction brought
about by fatigue. By repetition, muscular contraction
changes, becomes slower, has a long period of de-
contraction as in the case of lower animals. I even
think — excuse the temerity of these suppositions —
that there must be in these different muscles and in
these different states of activity of the muscle some
anatomical differences. Great stress has been laid
recently on the two organs that exist in the muscular
fibre : the fibrils which give short contractions, and the
sarcoplasm which gives long and permanent contrac-
tions. The latter predominates in the smooth fibres of
the viscera, the former in the striated muscles of the
voluntary movements. I suppose that it will be possi-
ble later on to observe some modifications in the pro-
portion of these two substances in the muscles of dif-
ferent animals according to their state of evolution, and
in the different states of the same muscles in rest or in
fatigue, for instance.
Now action, by becoming unconscious in hysterics,
by separating from consciousness, loses something of
its dignity, retrogrades in a manner and assumes an ap-
pearance that recalls the action of the visceral muscles,
the action of the lower animals, and the movements of
the fatigued muscles, as if the activity of the sarcoplasm
prevailed over that of the fibrils. This is what, in my
opinion, gives to the subconscious actions of the hysteric
those abnormal characteristics we saw in tremors and
contractures. It is this general idea that prepares us for
the examination of the phenomenon of hysteric paralyses.
LECTURE VII
PARALYSES — DIAGNOSIS
The clinical study of hysteric paralyses — The beginning of
these paralyses — Traumatic neuroses — The most fre-
quent types of paralysis — The diagnosis of hysterical
paralyses — The intrinsic characters — The localization
and form of the paralysis — The examination of the
reflexes — The value of the different signs '— The
extrinsic characters — • The modification of sensibility
— The description of hysteric anesthesia
FASHIONS prevail in medical studies as in costumes.
At one time, one problem raises general enthusiasm, and
everybody gives it his exclusive attention, forgetting all
the others. Twenty years ago, it was hysteric som-
nambulism that was in fashion; nowadays, one seems
very much behind the age when one speaks of som-
nambulism. The latest fashion is to apply one's self
only to the study of hysteric paralysis. Let us follow
the fashion and reflect for a time on this curious problem
of physiology and psychology. This lecture will be de-
voted to the study of hysterical paralysis from the
clinical point of view. The next lecture will analyze
the psychological features of paralysis and anesthesias.
The hysteric are capable of completely paralyzing a
part of their body. You know what I mean by such
an expression. I need only state that patients who
have had the accidents we spoke of before, fits of all
138
Paralyses — Diagnosis 139
kinds, simple or complicated somnambulism, choreas
of a special kind, mysterious contractures like those we
have seen, may besides have paralytic accidents. It
does not mean that a paralysis that presents itself in a
woman who has had fits and somnambulism is neces-
sarily a hysteric paralysis, obeying the psychological
laws of this kind of disease. It even seems to be the
clearest result of the present studies, which have spread
everywhere nowadays, to show us that it is not always
so; that often, very often even, the paralysis that ap-
pears is a commonplace paralysis, corresponding to a
cerebral or medullary lesion. The diagnosis to be
made is exceedingly difficult and important, but it is
nevertheless true that, in a certain number of cases,
these subjects have paralyses analogous to their other
accidents, whose evolution is the same and whose diag-
nosis and nature we must study.
These paralyses appear in about the same circum-
stances as the other phenomena ; they are always brought
about by an accident which, while very slight in itself,
is accompanied by a violent moral emotion and by dis-
turbances of the imagination. One of the oldest cases,
and a very interesting one from a historical point of
view, is quite typical. I allude to the observation of
Estelle, which originated the remarkable book of an
old magnetizer, M. Despine d'Aix,1 in 1840: A girl
1 Dr. Despine pere (d'Aix). De I'emploi du magnttisme animal
dans le traitement des maladies nerveuses, suivi d'une observation trls
curieuse de guerison de n&vropathie. 1860.
140 The Major Symptoms of Hysteria
twelve years old had fallen into a passion, and, against
her mother's will, had quarrelled and fought with one
of her little friends. In the heat of the fight, she had
been knocked to the ground, and had fallen rather
violently on her posterior. This fall had been com-
plicated by an aggravating circumstance ; namely, her
frock had been much dirtied in a particularly significant
part. The pain was slight and did not prevent the girl
from getting up again and returning home; but what
is essential is that she experienced a feeling of shame,
of fright, and tried to -hide her fault. The next day
began a complete paralysis of both legs, a serious
paraplegy which lasted eight years. Bear this in mind —
eight years' paralysis of the lower limbs for having fallen
lightly on her backside.
Such facts were hardly known at that time to any
but to those strange magnetizers. The same authors
of whom we spoke lately, Brodie, Todd, Duchenne (de
Boulogne), Russell Reynolds, Charcot, Oppenheim, and
all the modern authors, were the ones who began to
study what was first called traumatic neuroses. Indeed,
traumatic accidents are among the most frequent causes.
Railway catastrophes give rise to many of these acci-
dents, and some physicians had even adopted the ex-
pression of railway spine. Falls from carriages, from
horseback, and shocks received in battles are their most
common origin.
For instance, a drunken carter falls from his box on
his right arm and presents a paralysis of this arm. A
man of eighteen falls in a staircase on his back ; the con-
sequence is a paralysis of the legs and a contracture of
Paralyses — Diagnosis 141
the lumbar muscles. Often the shock is only imaginary ;
the celebrated patient who appears in the first lessons
of Charcot thinks he has been wounded by a carriage
which did not run over him. One of the last observa-
tions I have noted is very strange: A man travelling
by rail had done an imprudent thing: while the train
was running, he had got down on the step in order to
pass from one door to the other, when he became aware
that the train was about to enter a tunnel. It occurred
to him that his left side, which projected, was going to
be knocked slantwise and crushed against the arch of
the tunnel. This thought caused him to swoon away,
but, happily for him, he did not fall on the track, but
was taken back inside the carriage, and his left side
was not even grazed. In spite of this, he had a left
hemiplegy.
Other circumstances may act similarly, as, for in-
stance, fatigues, especially when located in a limb. A
house-painter felt his hand very tired while painting a
ceiling, and presented a severe paralysis of his right
hand. I found it likewise in a girl who was learning
the violin, in those who had tired their hands on the
piano. But here again, to the fatigue must be added
an emotional state, as in this classical observation of
Fere* ; a girl who tires herself in learning a piece on the
piano is seized with a paralysis of her right hand at the
moment when she is to play this piece at a ceremony.
The part of emotion is so great that it may be sufficient,
when added to a purely imaginary fatigue, as in this
other observation of Fe"re" : a girl dreams at night that
she is pursued by a man and that she runs very fast in
142 The Major Symptoms of Hysteria
the streets of Paris; she dreams that she is exhausted
with fatigue, though she has not moved. The next day
she is none the less paraplegic. Lastly, there are some
paralyses that follow somnambulisms and crises, with-
out our knowing very well for what reason, but as we
shall see later on, they affect limbs formerly paralyzed,
or having in them causes of decay, rachitic deforma-
tion, old scars, varices, etc.
The paralyses thus brought about may be very
various. For the present, I only point out to you those
most common and most anciently studied ; I reserve
others for the end of this study, because they are par-
ticularly interesting as regards the interpretation. The
most common hysteric paralyses seem to be analogous
to the great organic paralyses. The most frequent, the
most carefully studied, nowadays, is great hemiplegy, in
which one half of the body is completely paralyzed.
Usually, it is true, hysteric paralysis strikes the limbs
rather than the face, but the rule is not absolute ; when
the paralysis is in the right side, for instance, the face
and speech may be paralyzed as well as the arm and
leg. Here is a girl of nineteen, already neuropathic, and
daughter of an epileptic mother, who lost her father a
fortnight ago. The poor girl supported him with her
right arm during his agony ; on the very evening of the
day on which he died, she felt exhausted with fatigue,
especially in her right side, and her right leg trembled
when she tried to support herself on it. She could not
sleep, thinking every moment she saw and heard her
father. The next morning, she had a pain in her
abdomen, the menstrual discharge reappeared out of
Paralyses — Diagnosis 143
its period, the weakness in the right side had increased.
On the third day the right arm and leg could still move,
but trembled continually. On the following day the
right hemiplegy was complete and speech was entirely
lost. After a fortnight the movements were, little by
little, completely restored. I will observe to you here
that this hemiplegy may appear in a more dramatic
manner, after a convulsive fit or a profound sleep, which
then absolutely simulates the apoplectic stroke. In
such cases, the diagnosis is very delicate; though the
hypothesis of a hemiplegy and a hysteric sleep is diffi-
cult and rare, you must however think of it. Not long
ago, I recognized an accident of this kind in a man
sixty years old, who, at first sight, looked quite as if he
had had an apoplexy.
The second severe and frequent form is paraplegy,
in which both legs are completely paralyzed. This
accident often appears when an individual is seized
with an emotion while walking. It is about what
English physicians call the "giving way of the legs."
A young woman of twenty-five (what is strange is that
she was a nurse, who, as such, ought to have known
better) was one evening crossing a dormitory ; she saw
a patient in a crisis of somnambulism getting up and
going about wrapped up in a sheet. She took her for a
phantom, was terribly frightened, felt her legs shake
under her and fell down without being able to get up
again. She remained paraplegic for several months.
You must also beware of these paraplegics after child-
births, and after somewhat long diseases in which the
subjects have remained long in bed.
144 The Major Symptoms of Hysteria
The third form will be monoplegy, which strikes a
limb or a segment of a limb, for these paralyses may be
very limited. With the painter I spoke of, it affected
only the right wrist ; in other cases it affects the articu-
lation of the elbow, or the shoulder, the foot, or the
whole of the leg. A long discussion, which is not yet
quite settled, bears upon the existence of hysteric facial
paralyses. Charcot denied them and maintained that
what was called a paralysis of the right side of the face
was nothing but a contracture of the left side. He
only admitted in the face the existence of the glosso-
labiate spasm. This opinion has been much contra-
dicted and many cases of facial paralyses have been
brought forward which seem tc^ be typical. For my
part, I do not see why paralysis of the eyelids, mouth,
and cheek should not exist, and I have recognized some
cases of this disease which seem to be convincing.
Lastly, there may be paralyses of the trunk, and I
refer you to the most interesting, in my opinion, of the
studies I have had the opportunity of making on this
matter. The subject is a girl who had fallen into a
well, and who, after this accident, presented a remark-
able flaccidity of all the muscles of the trunk. She was
quite unable to stand or sit, her head and body fell in-
differently on every side. At the same time she had a
remarkable paralysis of the diaphragm, on which we
cannot insist for the present.1 Such are the chief forms
presented by hysteric paralyses. I must now some-
what insist on their diagnosis, which is of capital im-
portance for you.
1 N£vroses et Idees fixes, I, p. 328, II, p. 411.
Paralyses — Diagnosis 145
n
The diagnosis of hysteric paralyses can be made in
two manners. First, in an extrinsic manner, which was
formerly considered as the more important. In this case
you examine the symptoms that are foreign to the pa-
ralysis itself, the disturbances of the sensibility, the dis-
turbances of the intelligence, the simultaneous phenom-
ena, the circumstances of the appearance, etc. Secondly,
you can make this diagnosis by an intrinsic examina-
tion, which chiefly takes into account the paralysis itself
and its clinical characteristics. This second method ap-
pears nowadays to be more accurate and scientific and
is often preferred. As I told you, the fashion nowadays
requires that you should discover the curious little
modifications of the reflexes which may characterize a
paralysis without having to make any inquiry of the
patient or those around him.
Let us then first give our attention to those intrinsic
characters, since, at the present time, they are con-
sidered as more serious. You may first, in certain
cases, take into account the localization and form of
the paralyses. An Austrian author, Professor Freud,
has insisted a great deal on this point. Hysteric
paralysis never affects only one muscle, it is always a
paralysis in a mass, which strikes a group of muscles.
Do not suppose that every group of muscles may be
thus affected. The group that is affected is always
one that is necessary to a function of a part of the body.
Yet the paralysis does not extend beyond the limit of
146 The Major Symptoms of Hysteria
the muscles necessary for the functioning of this part
of the body; it does not easily encroach upon other
regions. It is otherwise in all organic paralyses; a
lesion of a nerve may affect only certain muscles; a
lesion of a nervous plexus affects several muscular groups.
For instance, in the paralysis of the leg brought about
by hysteria, the thigh and buttock are affected, but the
sacral region and the genital region are intact, which is
not the case in spinal paralyses. The same author re-
marks further that hysteric paralysis is often seated in
the extremities of the limbs only, which does not
happen in organic paralyses, the latter more often
affecting segments that are near the centre.
Notice also that hysteric paralysis is exaggerated,
always carried to an extreme, which is very rare in
organic paralyses. A man whose hemiplegy is con-
sequent on a cerebral hemorrhagy can still move a
little, and makes some efforts to conceal his paralysis;
one in whom hemiplegy is due to hysteria has no longer
a shadow of a movement in his diseased side. Hence
comes this difference in the gait which Todd and Charcot
formerly pointed out, and for which they invented rather
barbarous Greek words. The subject affected with
organic hemiplegy, they said, has a helicopode walk ; he
walks helically, throwing his paralyzed leg sideways by
a movement of his loins. The subject affected with
hysteric hemiplegy has a helcopode walk; he drags his
paralyzed leg in walking as if he did not trouble him-
self about it in the least, as if it no longer existed at all.
To these positive characteristics are added negative
characteristics; hysteric hemiplegy is not accompanied
Paralyses — Diagnosis 147
by any other serious disturbances in the diseased limb;
in particular, there is no atrophy, or at least a very
long time is required for it to appear after the period
of immobility; so you must always carefully meas-
ure the two limbs of the patient. The existence of a
notable atrophy will help you to recognize certain lesions
of the medulla or brain. Nor are there any disturbances
of the electric reactions; the reaction called reaction of
degeneration, which is so rapid in certain forms of
medullar lesions, does not exist in hysteric paralysis.
We come, at last, to the question of the reflexes, now
considered as very important, chiefly, it must be said, on
account of the studies of a French physician, M.
Babinski, who has devoted himself to this subject. In
a general way, all the reflexes of a limb must remain
normal in a hysteric paralysis. This may easily be
understood, since these reflexes depend for the most
part on lower medullar or cerebral centres which are
supposed not to be affected with any disturbance. On
the contrary, in an organic lesion, a certain number of
reflexes must always be injured, because the lesion
always bears more or less upon one of these centres.
You have first to consider the tendinous reflexes in the
elbow, wrist, knee, tendon of Achilles. They must not
be suppressed, as in tabes, nor exaggerated as in cerebral
hemorrhagy or in the lesions of the pyramidal tract.
You will seek, especially in the foot, for the epileptoid
trepidation. The clonus determined by the sudden
raising of the foot which appertains exclusively to the
lesions of this pyramidal tract, does not exist in hysterical
paralysis.
14.8 The Major Symptoms of Hysteria
You will also examine the cutaneous reflexes ; for in-
stance, Babinski has shown the very important sign
given by the toes, when the ball of the foot is slightly
rubbed with a pin. In normal adults — for there are
some irregularities in children — the toes bend together
towards the sole of the foot. In the lesions of the
medulla, on the contrary, you' observe a raising and
extension of the toes, but nothing like this can be ob-
served in hysteria. Excitation of the skin in different
regions of the body, on the internal face of the thighs,
on the abdomen, on the neck, determine in a normal
man contractions of the "peaucier" muscles, that is to
say the muscles of the skin, which disappear in organic
accidents and not at all in neuropathic phenomena.
Don't forget to examine carefully the reflexes of the
pupils to light, to accommodation; the slightest dis-
turbances of these reflexes must put you on your guard.
You know that the least alteration of these reflexes
strongly inclines you to admit organic lesions, either
those of tabes or those of syphilitic meningitis.
Lastly, Babinski has shown the importance of the
preservation of the muscular tonus in hysterical paralyses.
He insisted too with great accuracy on the preservation
of certain unconscious movements produced by associa-
tion in these apparently paralyzed limbs. This fact is
analogous to the observation of the preservation of cer-
tain subconscious sensations in spite of hysterical anes-
thesia, that we have to study in the following lecture.
According to these authors, this ensemble of signs is
absolutely characteristic, and it is possible to recognize
a hysteric hemiplegy solely through this objective ex-
Paralyses — Diagnosis 149
amination which requires nothing of the patient's psy-
chological observation. The thing is perfect theo-
retically, but practically it is much more difficult than
is supposed. Most of the signs we have spoken of,
when treating of the localization of paralysis, either are
indecisive or apply but to quite particular cases.
The signs of the reflexes are much more important,
but can we absolutely trust them ? First of all we must
eliminate the signs derived from the mere exaggeration
of the tendinous reflexes. You cannot eliminate hysteria
merely because a patient throws his leg upward too
strongly after the shock of the rotular tendon, for this
exaggeration of the reflex is exceedingly difficult to ap-
preciate and very irregular. A very great number of
subjects, when a little moved or nervous, throw their
legs too strongly upward when their knee is struck. It
may be said that one should distinguish the real reflex,
which is quick and simple, from the semi-voluntary,
semi-emotional movement which is added to it, and
which is too tardy, too long, too much generalized. All
this is true enough, but, in practice, I defy you to make
the distinction, and moreover I am inclined to believe
that in hysteric and neurasthenic patients there is often
a real exaggeration of the reflexes, which is perhaps
due to a diminution of cerebral inhibition.
The sign of the clonus of the foot has more importance.
The significance is much discussed at the present time,
and several authors point out cases of unquestionably
hysteric paralyses in which it has been met with. Some
authors maintain that if they take the graphic of the
shake with the registering apparatus, they recognize the
150 The Major Symptoms of Hysteria
regularity of the organic clonus in contradistinction to
the irregularity of the hysteric clonus. But this is not
quite certain.
Babinski's sign of the toes is exceedingly interesting.
In reality, you need not hesitate when it manifests itself
clearly ; I don't think it has yet been distinctly observed
in a hysteric paralysis. But it is an irregular sign, which
often fails totally. Many subjects do not react at all
or react by a retraction in a mass of the leg. The
pupillary reflexes are likewise of capital importance;
be always on your guard when you meet with the sign
of Argyll Robertson. But this sign is not absolutely
characteristic either; first of all, many neuropathic
patients have pupillary dilatation, then, in some
hystericals, there are contractures of the iris with dila-
tation or myosis, which prevent the reflexes from taking
place easily and may again be causes of error.
In a word, it is certain that the intrinsic examination
gives us exceedingly valuable indications. The in-
vasion of the face, the disturbances of speech, the
clonus, the signs of the toes, the pupillary disturbances
are strongly in favour of an organic lesion. Unfor-
tunately they are not absolutely certain signs, and I
think one is quite wrong in making things more diffi-
cult than they are, in refusing the unquestionable
services rendered to diagnosis by much more charac-
teristic extrinsic signs.
Ill
The most important extrinsic sign of all is derived
from the examination of sensibility, the modifications
Paralyses — Diagnosis 151
of which are of the greatest importance in hysteria. We
already met with them when studying choreas and
contractures ; we observed that the hysteric patient often
appears not to know what is going on in her arm or
leg, that she does not feel the fatigue of her protracted
shakes or contractions, and that, what is more, she
may not feel the movement of which her arm is the seat.
This anesthesia is still more characteristic in paralyses.
We must therefore insist now on its study.
For a long time physicians had had some vague
notions about the odd insensibilities of these patients.
You know that in the Middle Ages people recognized
witches and possessed persons by seeking on their
bodies for what was called the claw of the devil. It
was a more or less extensive part of the skin in which
the subject was insensible to any touch or prick. The
expert entrusted with this work would close the eyes of
the subject, and, armed with a sharp needle, prick here
and there the different parts of the body. The sufferer
was to answer with a cry to each prick, and the claw
of the devil on a certain spot was recognized from the
fact that he did not cry when this spot was examined.
Later on, Sydenham, in 1681, then Louyer Villermay
in 1816, Georget in 1824, Landouzy in 1846, later still,
Briquet, Charcot, and all the modern authors have
strongly insisted on all the varieties of this phenomenon.
For the present we shall attend to the indications that
anesthesia can give us as regards the diagnosis of
hysteric paralyses, and especially to its seat and depth.
This insensibility must be sought for this purpose in
three organs, on the skin, on the mucous membranes,
152 The Major Symptoms of Hysteria
and in the muscles. It may indeed extend either over
the cutaneous coat of the limb, or over the accessible
mucous membranes of the natural orifices, or it may
bear upon the sensations of motion and upon the notion
of the position of the limbs. In the first case, we have
to examine the skin and mucous membranes as re-
gards contact by passing our finger or a blunt instru-
ment over them. We may hope to obtain more accu-
rate results by the use of the aesthesiometer, which shows
us how the subject recognizes the differences of sensa-
tion depending on the different spots of the skin. You
will examine on these same regions the temperature-
sensations by alternately applying on the skin, unknown
to the subject, a cold and a warm object; lastly you
will examine the sense of pain by pinching, by stick-
ing in a needle, or by using one of the various algesi-
meters. You will thus find that these various sensibili-
ties may completely disappear, either simultaneously or
separately. It is not rare to find absolute insensibility
of the skin accompanying hysteric paralysis.
You will then examine the so-called muscular sen-
sibility by displacing the limb in different ways and
asking the subject to describe these positions and move-
ments without looking at them, or better still, to repro-
duce them with his uninjured arm. Here again you
will often find in hysteric paralyses complete insen-
sibility to position, the subject no longer possessing any
information about his diseased limb.
The existence of such anesthesias already gives you
an important piece of information. No doubt anes-
thesia exists in organic lesions, but it is much rarer
Paralyses — Diagnosis
'53
and, in general, not nearly so deep as in hysteric
affections. Further, it is easy to acknowledge that the
anesthesia when it is connected with hysteria presents
certain characters that are not to be found when the
insensibility depends on organic affections of the ner-
vous system.
One of the characteristics of this anesthesia, and one
that plays a most important part in the diagnosis, has
been well illustrated
by Charcot and
nowadays still ap-
pears to us to be
very significant : the
localization or the
place of this insen-
sibility. Charcot
used to say that in
hysteric paralyses
anesthesia takes the
form of geometric
segments, meaning
that it is termi- FIG. 8. — Schema of hysteric left hemianes-
nated by distinct, thesia-
regular lines assuming definite forms which can be
foreseen. Of course, when the hemiplegy is complete
and the hemianesthesia is also complete, the form is
very clear, but has no great significance ; it stops just
at the median line of the body, dividing into two equal
parts the forehead, nose, mouth, breast, and abdomen
(Figure 8). This section is curiously regular ; on the one
side, the skin is absolutely insensible, as well as the
154 The Major Symptoms of Hysteria
mucous membranes and, as we shall see later on, the
organs of the senses. On the other side, the sensibility
is intact. You may barely observe some transition,
some degradation on the median line of the body. On
one side, the subject feels nothing; on the other, she
feels quite normally. It is true even of the mouth and
tongue ; the separating line is found on the palate and
tongue. This hemianesthesia exists also in certain
forms of organic lesions, in certain lesions of the in-
ternal capsule ; one may at most say that it is rare, and
that, in general, the separation is not so clear, that
there is a broader line of demarcation, with confused
sensibility. One may say, too, that usually the troubles
of sensibility are more severe in the extremities than at
the root of the limbs, instead of being regularly the
same in all the parts as in hysteria. But, of course, in
this case the form of the anesthesia will not give you
much information.
In the other paralyses, the form of the anesthesia is
more instructive ; it seems to terminate precisely enough,
above the paralyzed organ by a nearly circular line
traced by the plane perpendicular to the axis of the
limb. Thus a paralysis of the hand brings about an
anesthesia of the hand extending up to the wrist and
terminated by a line in the form of a bracelet (Figure 9) ;
an anesthesia of the whole of the arm is limited by a
line including the shoulder, passing a little under the
arm-pit, in the form of a jacket-sleeve, as Charcot used
to say. A paralysis of the foot brings about a sock or a
stocking of anesthesia. A paralysis of the leg gives
birth to an anesthesia in the form of a leg of mutton,
Paralyses — Diagnosis
'55
which generally spares the anus and the genitals
(Figure 9).
Now these forms of anesthesia, which look so simple,
are particularly extraordinary from a physiological
point of view. They
by no means cor-
respond to the dis-
tribution of the
nerves or even of
the nervous plex-
uses. You know
that the hand is in-
nervated by three
principal nerves,
the radial, the me-
dian, and the cubi-
tal. A section of
one of these nerves
brings about a well-
known anesthesia of anatomic form corresponding to
the distribution of the nerve. You know, for instance,
the old anesthesia of the lesions of the cubital, which
only affects the little finger and the longitudinal half of
the fourth (Figure 10) : it is not at all like our geometric
segments in the case of a paralysis of the hand. A
lesion of the brachial plexus anesthetizes only a part
of the arm, and the limit of the anesthesia affects a
special form, because it reserves the sensibility of a
portion of the shoulder above the deltoid, which is in-
nervated by the cervical plexus (Figure 1 1). A lesion of
the sacral plexus brings about, it is true, the anesthesia
FIG. 9. — Schema of various forms of local-
ized hysteric anesthesia.
156 The Major Symptoms of Hysteria
of the thighs on their internal face, but affects the anus
and the genitals. On this distribution of the insensi-
bilities and on the places of the reserved regions is
founded the anatomic diagnosis of the lesions of the
nerves and of the tumours of the medulla. But it is
Mcdtin
FIG. 10. — Cutaneous territories of the peripheric nerves in the right arm.
A, anterior face; P, posterior face. (See Dejerine, " S6miologie du Sys-
teme nerveux," in " Traite de Pathologic Generate," V, p. 952.)
not possible to connect the forms of anesthesias we just
observed in the hysteric paralyses with these forms given
by the organic lesions.
This difficulty of localization was so great that Briquet
tried to make other hypotheses and asked himself
whether the distribution of hysteric anesthesias did not
depend on the vascular circumscriptions, on the cir-
l
Paralyses — Diagnosis 157
culation of the blood, more than on the nervous cir-
cumscriptions. Now we see that such is not the case,
there is no arterial irrigation in the form of a wrist band,
a jacket sleeve, or a leg of mutton. This form of an-
esthesia is something quite peculiar.
I have tried formerly to sum up these localizations
of hysteric anesthesia by a word that has had success ;
the hysteric patient, I said, seems to attend to the popu-
FlG. ii. — Localization of the anesthesia in a case of a lesion of the
brachial plexus. Id., ibid., p. 951.
lar conception of the organ rather than to its anatomic
conception. For the common people, what is an eye?
It is the ensemble of the organs that fill the orbit, eye-
lids included, and, in fact, the hysteric person who has
anesthesia of the eyes has on her face, as it were, a pair
of spectacles of anesthesia (Figure 9) affecting the two
eyelids in their central part. For the common people,
the hand terminates at the wrist. They don't care if all
the principal muscles that animate the hand and ringers
are lodged beyond in the fore-arm. The hysteric
person who paralyzes her hand seems not to know that
158 The Major Symptoms of Hysteria
the immobility of her fingers is due in reality to a mus-
cular disturbance in her fore-arm. She stops her
anesthesia at the wrist, as would the vulgar, who, in
their ignorance, say that if the hand does not move,
it is because the hand is diseased. Now this popular
conception of the limbs is formed by old ideas we have
about our limbs, which we all keep in spite of our
anatomic notions. So these hysteric anesthesias seem
again to have something mental, intellectual, in them.
This characteristic, though really very important,
might still, however, give rise to some cavilling. There
are in intoxications, in alcoholism, for instance, in-
sensibilities in the form of a sock or a boot. In the
medulla, segmental localizations have been studied that
may lead one to conceive anesthesias of the same kind.
Practically, you will be right nine times out of ten in
basing a diagnosis of hysteric paralysis on this geometric
form of anesthesia, but, in order to avoid the least
chances of error, we must insist on the last characteristic,
to which we have just come, namely the mental char-
acter of this anesthesia. It is, moreover, this character
which will enable us to arrive at a more intelligible
conception of the paralysis itself. Such will be the
object of our next lesson.
LECTURE VIII
THE PSYCHOLOGICAL CONCEPTION OF
PARALYSES AND ANESTHESIAS
The problem of hysterical anesthesias — Absence of any
modification of the reflexes, of any physiological dis-
turbance— Indifference of the patient — Mobility of the
anesthesia under various influences, attack, sleep, intoxi-
cation, somnambulism, suggestion, emotion, and above all
attention — Contradictory character of this anesthesia —
The part played by absent-mindedness — The dissociation
of certain groups of sensations in the anesthesia — The
indifference, the lack of representation and memory in the
paralysis — The astasia- abasia — The systematic paraly-
ses — The dissociation of a system of movements — The
system of movements and sensations in a function —
Hemiplegy and paraplegy as dissociations of functions
THE time has now come to give our attention to some
psychological studies on hysteria that had a great
development in France about twenty years ago, and
have contributed much to the development of patho-
logical psychology. They are perhaps rather special,
having perhaps a less general importance than we then
thought, but without them we could not understand
the particular nature of hysterical anesthesia, nor even
perhaps form with sufficient clearness a general idea of
the hysterical disease itself and especially of the paraly-
160 The Major Symptoms of Hysteria
ses that exist in this disease. We shall insist on the
mental characters of anesthesia, and try to derive from
them a general conception, and then we shall see that
it finds its application in the study of paralyses, which
we shall take up again from a new point of view.
We have already seen that hysterical anesthesia
presents certain oddities which ought to attract the
physician's attention. It is accompanied by a very
deep and even exaggerated paralysis, and yet does not
determine any serious objective disturbance. Is it
not odd to see a limb remaining quite insensible, quite
paralyzed for months and sometimes years together
without any serious atrophy, without any modification
of the electric reactions and, above all, without any
change in the reflexes? Certain reflexes in particular
astonish us very much; the reflexes of the erectile
organs, those of pain remain intact. You know, for
instance, that if you determine a strong pain by pinch-
ing the skin at any point whatever of the body, the pupils
contract suddenly. This fact persists with our hys-
tericals who declare they feel nothing. The vascular
reflexes in relation to the sensations of cold and heat
are very delicate. M. Hallion recently contrived to
study them with great accuracy by means of a delicate
little apparatus which he invented. The application
of a little ice on the fore-arm immediately brings about
the contraction of all the vessels of the hand. At my
request he was so kind as to study the fact with my
The Psychological Conception 161
patients, and found that the most anesthetic hystericals
reacted quite correctly in this respect.
Besides, we know quite well what the disappearance
of the cutaneous sensations produces, in practice. Phys-
iologists have shown that when the limb of an animal
is made insensible by the section of the sensitive root,
this limb, quite intact at first, cannot, nevertheless, be
preserved ; it is not long in becoming unclean and cov-
ered with sores, and it disappears little by little, for
the animal itself bites it off. Sensibility is a safeguard
for our limbs. We may observe the fact in a well-known
disease. You know those patients who come to the
consultation to complain that their hands are constantly
burnt or wounded. They have scars of burns on their
fingers and are not able to avoid this accident. They are
syringomyelic patients and the lesion of their spines
makes them insensible to cold and heat. Why is
there nothing of the kind to be found in our anesthetic
hystericals ?
This absence of objective disturbances is mostly
accompanied by a very curious subjective symptom;
namely, the indifference of the patient. When you
watch a hysterical patient for the first time, or when you
study patients coming from the country, who have
not yet been examined by specialists, you will find, like
ourselves, that, without suffering from it and without
suspecting it, they have the deepest and most extensive
anesthesia. Lasegue, who analyzed very carefully
many of the subjective characteristics of hysteria, has
often pointed out this ignorance among the patients.
Charcot has often insisted on this point and shown that
1 6a The Major Symptoms of Hysteria
many patients are much surprised when you reveal
to them their insensibility. Recent authors are also
agreed on this point. It is far from being the case with
anesthesias of organic origin. That particular symp-
tom of tabes, which Charcot was one of the first to
describe and which he has called the tabetic mask,
is well known. The patients lose the sensibility of a
part of the face, more or less extensive, but they account
for it subjectively, and declare that they experience
a horrible feeling in regard to it. Ask hystericals who
have facial anesthesia — and they are legion — whether
they experience a horrible feeling about it, and they will
all tell you that they do not care.
To explain precisely this important difference between
hysterical anesthesia and anesthesia of organic origin, it
will not be out of place, we think, to relate a little anec-
dote. We did not obtain it ourselves, but it was given
to us by our brother, Dr. Jules Janet. When he was
house surgeon at the Pitie with Dr. Polaillon, he had an
opportunity to observe the following case : A young girl
of about twenty had met with a rather serious accident.
She fell through a glass door, and a piece of glass cut
into her right wrist just below the thenar eminence.
The hemorrhage was stopped, and the wound had united
fairly well when, a few days after the accident, the young
woman presented herself for treatment. She expe-
rienced a certain numbness in her right hand, but no
paralysis was present. She complained particularly
of a persistent insensibility, most inconvenient, in the
palm of the hand ; this slight anesthesia about the fingers
was in fact complete at the level of the thenar eminence.
The Psychological Conception 163
The case was evidently one of a more or less complete
severing of the median nerve, and especially of its super-
ficial branches. But while accepting the observation
of the patient, we made a singular discovery. She
was a hysterical, and on her entire left side she was
completely anesthetic, of which fact she had not said a
word. The physician joked her about it : "How is it,
miss, that you come here complaining about an insen-
sibility that affects but a small portion of the palm of
your right hand, while you do not even notice the much
larger insensibility of the whole of your left side ? " The
poor girl looked surprised and ashamed. To our mind
she might have replied to her doctor with much more
assurance, and said : " Be that as you think, sir, I
came here to tell you what ails me ; it is the insensibility
of the palm of my right hand that troubles me, and that
of my left side has never given me any trouble. You are
the doctor; explain it as you like."
To these general remarks must be added all that
we have already said on the form of these anesthesias,
a form which has nothing anatomic or even scientific
in it and seems to correspond to false popular notions.
These remarks compel us to enter more deeply into
the scrutiny of the mental state corresponding to these
strange insensibilities. This study leads us now to
point out a new characteristic in the same order of
ideas, namely, the remarkable mobility of these anes-
thesias.
Unquestionably, some patients retain their stigmata
all their lives. Aurel. is still hemianesthetic at seventy-
five; Ler. has kept a hemianesthesia and a contraction
164 The Major Symptoms of Hysteria
of the visual field for forty years. We shall have to keep
an account of these cases; but generally, and perhaps
even among these very patients, without its having
been observed, anesthesia becomes modified and dis-
appears all at once for longer or shorter periods. It
varies from one moment to another, says M. Fere", and
under the influence of causes so slight that they may
pass unnoticed.
However rapid in their mobility, some of these changes
may nevertheless be studied, and one can note at least
some of the circumstances in which they are oftenest
affected. The attacks modify considerably the locali-
zation of sensibility. Many authors have noted
that anesthesias often increase at the time preceding
the attacks. For example, Marguerite X., who or-
dinarily has right-sided hemianesthesia, becomes, dur-
ing the hours that precede the attack, totally anes-
thetic. We point out a case much rarer still; it is
an opposite phenomenon. Cel., usually totally anes-
thetic, recovers complete sensibility sometimes during
a form of excitement which lasts half an hour before
the attack.
During the attack itself, when we can obtain some
intelligent sign (we have seen that it is generally pos-
sible), the sensibility becomes modified. Often, as
happens with Bert., it is recovered entirely. After
the attack, many patients, like Marg., return to their
usual condition ; others have for some time anesthesias
more extended than usual. Bert., generally hemianes-
thetic on the left side, remains, after the attack, totally
anesthetic and at times completely blind for some hours.
The Psychological Conception 165
It often happens, during natural sleep at night, that
tactile anesthesias disappear. It is very difficult to
verify the fact. We have to take the patients by sur-
prise at night, using all sorts of precautions not to
wake them. We pinch them on the anesthetic side.
They groan, turn over, complain in their dream, or
wake suddenly, exactly as a normal person would.
M. Jules Janet, when he was an assistant of Dumont-
pallier, has repeatedly verified this fact on two patients,
the observation of which he communicated to us. We
had the fact established on various persons, particu-
larly on Bert, and Is. Our friend, M. Dutil, was
kind enough to verify the fact for us on a hysterical, G.,
hemianesthetic on the left side. Pinched on that side
during her natural sleep, she winced and spoke in her
dream : "You are pinching me — how stupid — "
During certain intoxications that bring with them
states analogous to sleep, insensibility vanishes more
or less completely: many patients, totally anesthetic,
become entirely sensitive when drunk. Chloroform-
anesthesia in the period of excitation does away with
all stigmata, with the anesthesia as well as the con-
tractures. "Among the most paradoxical consequences
of the hypodermic use of morphine," says Mr. Ball,
"we must cite the restoration of cutaneous sensibility
with subjects who have lost it. ... A hysterical,
drugged with morphine, a dose of eight centigrammes
a day, felt all her pain disappear and her normal sensi-
tiveness restored. Abstinence brought back her hys-
terical symptoms." The same fact has been described
by M. Jules Voisin. In the same manner we see often
1 66 The Major Symptoms of Hysteria
a diminution of the anesthesia and a widening of the
visual field in hystericals who are under the influence
of morphine, and we could verify too the reappearance
of the anesthesia after the cessation of the influence of
the drug. Many other excitations must have analogous
effects.
The object of our first work * was, above all, the nu-
merous modifications of sensitiveness during states
of induced somnambulism. Certain subjects, under
rare conditions, recover suddenly and completely all
their sensitiveness as soon as they are in the second state.
This fact has been sometimes pointed out in old de-
scriptions of the magnetizers. We have very often
established these same facts at the outset of our re-
searches before we had read the very interesting obser-
vations of these authors. Sometimes the subjects have,
during their somnambulism, an anesthesia apparently
general; but the slightest excitation that directs their
attention somewhat upon tactile sensitiveness causes
this anesthesia to disappear, even on parts that re-
mained anesthetic when awake, despite suggestions.
This restoration to sensitiveness of some subjects
proceeds somewhat slowly and becomes evident only
when the hypnotic state has been considerably pro-
longed. Others again have a more complicated som-
nambulism; they pass through several states in which
sensibility and, above all, memory undergo many modi-
fications. It is only in one of these states, often a state
that develops after all the others, that the subjects
recover all their sensibilities.
1 " L'automatisme psychologique," 1889.
The Psychological Conception 167
Sensibility may be modified even in waking time.
Briquet has insisted on the action of electricity ; Burcq
and many others after him have shown that magnets,
metal plates, and many other agents, which all vary
according to the patients, have analogous effects. The
sensibility, increased by these agents, persists for a
longer or shorter time and disappears with oscillations.
The influence of suggestion, in general very powerful
with hystericals, may suffice momentarily to reestablish
the sensibility, but it should be borne in mind that this
phenomenon is far from being general, that, with a
number of patients, sensibility changes very little when
it is suggested, and on the contrary undergoes great
modifications under the influence of certain excitations,
such as drunkenness, or certain changes of psychological
state, as somnambulism.
Many other psychological phenomena come in to
produce, modify, or destroy anesthesia. For example,
strong emotion, preoccupation, reveries, increase it.
The association of ideas may in some cases modify it.
We say to one patient that she has a caterpillar on her
left hand, and she cries out and pretends that she feels
the tickling of it ; at this moment the whole of her left
arm has become quite sensitive.
But there is a psychological phenomenon which plays
a far more important part than any other, and its study
throws a great deal of light upon the problem; we
mean attention. To verify this fact, we must remember,
as we shall demonstrate later, that with hystericals
attention is altogether the most difficult thing to fix, and
that only a few can succeed in directing it. As a gen-
i68 The Major Symptoms of Hysteria
eral thing, we may for a moment attract their attention
upon their anesthetic hand by whatever means we
please. A patient does not feel the electric current
when he has his eyes shut. He acknowledges a tickling
on seeing the manipulation of the process. We fasten
a red wafer on Bert.'s left hand, she looks astonished
and stares at her hand. Let us leave her for a moment ;
then, when her head is turned, let us lightly pinch that
hand, so insensible but a moment ago. Bert, now cries
out when we pinch her and feels it quite perfectly.
It is true that this fine sensibility will not last long.
We take that wafer off and a few minutes later she can
no longer feel anything. All these phenomena, the
last particularly, are the origin of many difficulties,
for they very easily upset the sensibility that is the object
of the study. They increase the anesthesia, they fix
it, or suppress it ; they give it an extremely changeable
aspect, which discourages the observer.
Now it will be asked, does the anesthesia, at least
as long as it exists, present itself to the observer defi-
nitely ? Is it always very certain, in whatever way you
examine the subject ? By no means ; and we have to
point out a second series of observations which com-
plicate the problem of anesthesia still more, for they
present it to us not only as changeable, but as contra-
dictory.
Lasegue said in 1864 that hysterical anesthesia looked
strange, and that it seemed to be a psychological per-
turbation, a sort of alienation. The studies which sub-
sequently confirmed this theoretical conception were
at first observations on an altogether special point,
The Psychological Conception 169
namely, on unilateral amaurosis; that is, on certain
very interesting disturbance of the vision, about which
we shall speak in our next lesson.
If the unilateral amaurosis presents embarrassing
problems, it is the same with all anesthesias. Several
years ago, we made the following observation of a
patient in M. Powilewic's service at the Havre hospital.
She was attacked with hysterical paraplegia and pre-
sented a state of total anesthesia. We used to treat
her legs with electricity, and noticed the strong muscular
contractions she experienced at each contact of the
negative electrode, when all at once we saw that the
two wires which fastened the plugs to the apparatus
had dropped. For a long time we had thus been apply-
ing electricity with mere pieces of wood. We continued
without fastening the wires to the ends, and the con-
tractions were all the greater by the simple contact of
the plug. This, it will be said, is nothing very wonder-
ful ; there is a sort of habit in that a suggestion is taking
place. We think so too ; but how could this patient,
whose skin all over her body was wholly insensible,
and with her head well turned away, feel the moment
when the plug touched her legs, and make a movement
just then and only just then? We may every day ex-
perience a similar embarrassment. We propose to
Is. a little contrivance to verify her anesthesia quickly.
She is to answer " Yes" when she feels and " No" when
she does not feel anything. As she is very simple-
minded, she accepts without demurring, and we dis-
cover then a furious contradiction. Although she has
her eyes carefully concealed behind a screen, although
170 The Major Symptoms of Hysteria
we avoid any kind of rhythm and pinch her several
times irregularly on the same side before we pass over
to the other, she is never mistaken, and always says
"Yes" when we pinch her on the left and "No" when
we pinch her on the right. The same experiment
repeated on a man, Pasq., gives exactly the same results,
until he perceives the queerness of his answers and tries
to answer attentively. He then ceases, but only then,
to say "No" when we pinch his anesthetic side.
Here now is another observation which bears no
longer on the tactile but on the muscular sense. A
young woman, twenty-two years old, whom we have often
described by the name of Lucy, took during her attacks
certain cataleptic poses. For an hour, she would keep
her eyes fixed on the window and her arms raised in an
attitude of terror. For the present we must insist
on only one detail of this attack; we observed that
during the most normal of her waking states, it was
enough to raise both her arms, and place them in the
posture of terror which they took during her crisis,
to induce at once an attack. Of course, you will say
the thing is quite simple and well known. By the
position of the arms you call forth the principal idea
of attack, and the rest follows. True, but there is a
little detail yet. Lucy was anesthetic over her entire
body and presented nowhere any trace of muscular
sense. As often happens in this case, she would fall
down at once as soon as you closed her eyes. Now,
we have often taken the precaution to close her eyes
before displacing her arms, and the crisis occurred all
the same as soon as the members had the required posi-
The Psychological Conception 171
tion. How do you explain the notion of that position
being appreciated by so insensible a subject? All
these facts and a great number of others which have
been accumulated are very likely to puzzle the observer.
They show us that hysteric anesthesia not only changes
from one moment to another, but, indeed, varies in the
same instant and manifests itself by contradictory
phenomena according to the questions put to the subject.
II
We must rapidly lay aside a first interpretation of
these facts. The anesthesia of hystericals is extremely
changeable and contradictory. These patients pretend
not to feel, and by very simple artifices we can prove
to them that they feel perfectly well. Their insensi-
bility is, therefore, simulated, and our processes are
only means to deceive a deceiver and unmask a fraud.
This risumt of facts is, to our mind, altogether crude
and insufficient. Do hystericals take any particular
interest or pleasure in having their arms pierced through
with needles? Do these young girls pass through the
council of revision to simulate unilateral amaurosis?
How is it that, in all civilized countries, hystericals
should have agreed to simulate the same thing ever since
the Middle Ages to the present day ? .
We must not be content with this crude explanation,
and since anesthesia presents itself to us as a psycho-
logical fact, we must seek, among the few notions
psychology furnishes us, that which best summarizes
facts of this kind. We are happy to have Lasegue
172 The Major Symptoms of Hysteria
confirm an opinion which we have maintained for
several years ; hysterical anesthesia is a certain species
of absent-mindedness. "A person," said Lasegue
in 1864, "absent-minded through a great preoccupation,
does not perceive sensations which, in another frame
of mind, he would scarcely have tolerated. ... It
is probable that hystericals, whose moral state offers
so many other singularities, acquire likewise, through
their very malady, a sort of laziness that renders them
less apt to perceive certain psychic modalities."
This explanation based on absent-mindedness is, in
reality, but a first approximation. Anesthesia is surely
not ordinary absent-mindedness; it has much more
clearness and duration. It is far from disappearing so
easily as soon as the subject chooses, and above all,
it appears without there being any fixed idea of any
object which attracts the patient's attention to another
point. There is in it a pathological incapacity to
collect the elementary sensations in a general perception.
In reality what has disappeared is not the elementary
sensation, the preservation of which we have just seen ;
it is the faculty that enables the subject to realize this
sensation, to connect it with his personality, to be able
to say clearly : " It is I who feel, it is I who hear."
We shall .often have the opportunity to reconsider
this problem, but let us remark, by the way, that this
singular character of anesthesia is not unknown to us ;
after all, we have already seen something similar while
studying the amnesias that follow somnambulisms.
I have already told you that the subjects were unable
to remember what had happened during the fit of
The Psychological Conception 173
somnambulism, and even to remember the principal
idea which played a part in this state. Irene, whom I
have repeatedly spoken of, had forgotten after the crisis
not only the comedy she had played but also her mother's
death and illness, which were its starting point.
We accepted at that moment, without discussing it,
the description of this amnesia, for we did not want to
complicate the matter, but in reality that oblivion was
very strange. Was it real oblivion, the obliteration of
the recollections, the destruction of the images ? By no
means, since the patient could be cured and is now
able to relate clearly all those events. Was it then the
inability to reproduce them? Was it that the brain,
while keeping their traces, was nevertheless not able
consciously to cause them to reappear? By no means,
since the patient had dreadful fits every day during
which she recited all the details of the events. In a
word, she had forgotten nothing and she had the power
to recite everything. Then where was the oblivion?
The oblivion consisted only in this, that she could not
recite in a waking state, with full consciousness of the
other events and of herself. She could relate, it is true,
but in a dream, in a delirium, without having at the
same time the notion of herself. As soon as she had
the personal consciousness of her name, of her situation,
she could no longer associate the remembrance in
question. We tried to sum this up by saying that
somnambulism is not the destruction of an idea but
the dissociation of an idea, that has emancipated itself
from the ensemble of consciousness, and that the en-
semble of consciousness can neither recover nor control.
174 The Major Symptoms of Hysteria
Well, our anesthesias, which looked so strange, have
just presented to us the very same characters with more
clearness still. They are groups of sensations forming
a kind of system, that is to say the ensemble of sensations
coming from the hand or the leg, which can no longer
be connected with the totality of consciousness, although
they still exist on their own account and even determine
reflexes and usual movements.
Let us apply the same notion to our paralyses; we
shall see that the facts are absolutely of the same kind.
Besides anesthesia, on which we dwelt for some time,
there are other mental phenomena which accompany
hysterical paralyses. The most curious are connected
with a kind of indifference, analogous to the" one we
remarked in anesthesia. If we had a paralyzed arm, it
would inconvenience us exceedingly, we should fret
very much about .this disease, we should perpetually
regret our former state and be forever making desperate
efforts to recover the motion we had lost. We cannot
help therefore being somewhat surprised and ill-hu-
moured when we attend a paralyzed hysterical. This
kind of patients vexes us with their calm indifference and
inertia. One of their limbs being out of use does not
appear to incommode them ; they think it quite natural
to walk with but one leg, and do not make the least
effort to use the other leg. It was just this that deter-
mined the famous distinction Charcot made between
the helicopode and helcopode gaits. While the person
affected with organic hemiplegy labours hard to move
his restive limb forward, the hysterical drags hers after
her like a cannon-ball. She almost despises it, and
The Psychological Conception 175
she wants to beat it, calling it "an old stump," like
a patient Professor James has described.1
This conduct corresponds to a very special mental
trouble. If you- question such persons, you find that
they seem not to have kept the remembrance of their
limb, they do not know any longer what this paralyzed
limb used to do and they can no longer make the efforts
of imagination necessary to conceive it. Fe"r£ was one
of the first who insisted on this point. "After having
shut the patient's eyes," he says, "I ask her to try to
represent to herself her left hand executing movements
of extension and flexion. She is not able to do it. She
can represent to herself her right hand making very
complicated movements on the piano, but on her left,
she has the sensation that her hand is lost in empty
space. She cannot even represent to herself its form.2"
I have verified this remark more than twenty times.
This lack of representation and memory of the paralyzed
limb is one of the most typical things ; many authors
have remarked it. Here is the statement of an English
author, Dr. Bastian, who, by the way, has quite another
conception of hysteria than we; "When I ask her if
she can imagine that she touches the tip of her nose
with her left finger, she immediately answers: 'Yes.'
If I ask her to imagine the same movements with the
paralyzed hand, she remains hesitating and at last
answers: 'No.' She can imagine herself playing on
1 William James, " Notes on Automatic Writing." Proceedings oj
the Society oj Psychical Research, March, 1889, p. 552, and in "The
Principles of Psychology," 1890, I, p. 377.
2 Ch. F6i6, "La Pathologic des Emotions," 1892, p. 143.
176 The Major Symptoms of Hysteria
the piano with her left hand but not with her right
hand."1
The same remark applies to the old observations made
at the outset on the will of these patients. The English
author Brodie had already said : " In hysterical paralysis,
it is not the muscles which do not obey the will, it is
the will itself which does not enter into the action."
W. Page added: "When the patient says: 'I cannot,'
it means, 'I cannot will';" and M. Huchard said:
"They cannot, they will not will." What did these
remarks, applied to paralytics, mean? They meant
that the patient did not seem to make the initial effort,
to apply his consciousness to a certain act. He did not
even seem to have the representation of this act. All
these remarks are of about the same kind, and we find
again in paralyses dissociations of psychological phe-
nomena identical with those we have observed in
somnambulic amnesias.
There is but one difficulty left. What is the psycho-
logical phenomenon that dissociates itself? In som-
nambulism, it was the idea of an event, and was rela-
tively clear; but have we in our mind the idea of the
motion of our two legs ? Is it this idea that disappears
in its entirety and makes us lose the motion of our legs ?
It seems very odd, and we are not accustomed to apply
the word idea to the ensemble of the movements of our
two legs. To make the thing clear, we must now recall
certain forms of paralyses of which I have not yet
spoken and which will, I think, form the transition
1 Charlton Bastian, " Various Forms of Hysterical or Functional
Paralysis," 1893, p. 15.
The Psychological Conception 177
between the preceding phenomena of dissociation and
the great paralyses which we do not understand.
Ill
Several authors, one of the first of whom was Jaccoud,
and among whom we find Charcot, Blocq, and Se'glas,
had pointed out a form of hysterical paralysis still more
extravagant and unintelligible than the others.
The subjects are, as a rule, young people ; they seem
not to have the least paralysis of the legs, when you ex-
amine them in their bed. Not only are the reflexes
intact, but — and the fact is more surprising — the
movements are intact. If you tell them to raise their
legs, to bend, to turn them, they do exactly all that
is required of them. What is more, they have kept a
very great strength, quite the normal strength. They
push back your hand with their feet, they lift you up if
you bear down with all your strength on their knees.
Then, you will no doubt say, there is nothing at all the
matter with them. It is true, but they are absolutely
incapable of walking. If you cause them to stand on
the floor, they will bend, twist their legs, throw them
to one side and the other, and fall down without having
made one step : and this will last for weeks and months.
They realize the paradox of having no paralysis of
the legs and of being unable to walk. In a few, de-
scribed by Charcot, the comedy is still more complete ;
they are able to make with their legs certain movements
which seem very complicated, as jumping, dancing,
hopping on one leg, running, but they fall as soon as
they try to walk. Can you conceive such an absurdity ?
iy8 The Major Symptoms of Hysteria
For some time this disease, which was called astasia-
abasia, seemed to be almost alone of its kind, but soon
physicians were obliged to recognize that there were
many other paralyses belonging to the same type, and
that they were even frequent. Some subjects are still
able to walk, but cannot stand ; others have lost some
functions of the hands : they almost always forget their
trade; a needle- woman can no longer sew, an ironer
can no longer handle an iron, though they have no
paralysis of the hand. Frequently girls can no longer
write at all, or play on the piano." M. Babinski has
shown such cases for the functions of the mouth ; the
patient can no more blow or whistle, while he can make
all the other movements of the lips. These examples are
sufficient to prove to you that there are very often
systematic paralyses in which a certain system of move-
ments, grouped by education, separates from conscious-
ness and takes an existence of its own.
These phenomena come much nearer to our som-
nambulic amnesia. The oblivion of her mother's
death which came upon one of our patients, and of all
the care she had taken of her during her illness, was
the loss of a system of images and movements which
comes very near the oblivion of sewing or writing. You
understand that in these two cases, the group and the
more or less complex system are of the same kind.
Well, if it is not too bold, I will propose to you, not to
consider abasia as an exceptional hysterical paralysis,
but on the contrary to make it the type of all the other
hysterical paralyses.
The ensemble of the movements of the right hand is
The Psychological Conception 179
a system of images and movements, exactly as the en-
semble of the movements necessary to play on the piano.
Only it is a much more extended and, above all, a much
older system. It is the reason why it contains in itself
and involves all the sensations of the hand, whereas
playing on the piano involved only certain special
sensations. And what about the paralysis of the two
legs ? you will ask me. It is, in my opinion, exactly the
same. The two legs form a unity, not only anatomi-
cally but especially, psychologically speaking. Our
ancestors, the animals, constructed in their mind the
association of the limbs of the same level, of the same
segment. These limbs have a common role to play:
such a segment enables us to stand, such another to
seize objects. This system of images relative to the two
legs is very vast ; it contains subdivisions, as the system
that concerns walking, or jumping, but it can be dis-
sociated in its entirety. Lastly, since we are making
hypotheses, we must not stop half way; hysterical
hemiplegy is a phenomenon of the same kind as astasia-
abasia. The movements of one side of the body also
form a system : we have a very clear idea of the ensemble
of the actions of the right side as opposed to the en-
semble of the actions of the left side.
No doubt, you will tell me, these great systems of sen-
sations and images are at the same time anatomical
systems, which hav& a unity in the brain and in the
spine. I do not deny it by any means; the fact that
a system is psychological should not cause us to conclude
that it is not at the same time anatomical. On the
contrary, the one involves the other. When I begin to
180 The Major Symptoms of Hysteria
learn to ride a bicycle, I voluntarily group together
images depending on several centres and which have
never been grouped : consequently I am very awkward.
After some time, I can maintain my equilibrium on a
bicycle; it means that these different images have as-
sociated together and regularly call forth one another.
It is very likely that this functional association cor-
responds to an anatomical association which has been
effected among the different centres, and that a new
little centre has been formed in my brain, the centre
concerning bicycle riding. It is even because this centre
persists and develops, that next year I shall be able to
ride without learning again. With regard to new func-
tions, we understand easily that the system is at once
mental and physical ; but you should impress your mind
with the belief that your ancestors, the monkeys, learned
to walk on two legs as you have learned to ride a bicycle,
and that, before the monkeys, there were other beings
who learned to systematize the movements of one side
of their body and invented the right side and the left
side. This very old function has well organized cen-
tres, but it is none the less a function, that is to say,
a complete system of sensations and images.
Well, as the hysterical may lose, while they have
fits of somnambulism, a little system of thoughts that
emancipates itself, which loss brings on two symptoms,
somnambulic agitation and amnesia, so the same patients
may, in the same way, lose through dissociation a great
and old system of thoughts and sensations, that of
the right side or that of the two legs. And this new
dissociation will again manifest itself by two great symp-
The Psychological Conception 181
toms : first, by involuntary motor agitations, which we
studied in our last lecture in the form of choreas and of
more or less extended tics ; and secondly, by hysterical
paralyses. I don't insist on the details of these phenom-
ena, on the different degrees of these paralyses; it is
enough to have presented to you this general conception.
LECTURE IX
THE TROUBLES OF VISION
The troubles of different perceptions, touch, smell, taste,
hearing — The total dissociation of the function of vision
— Hysterical blindness — The partial dissociation of vision
— Unilateral amaurosis — The contradictory characters
of this amaurosis — The dissociation of the monocular
and the binocular vision — The narrowing of the visual
field — The dissociation of the peripheric and central
vision — The problem of hysterical hemianopsia compared
with hysterical hemiplegy — Dyschromatopsia — The
troubles of the movements of the eyes
You have just seen from our remarks on hysterical
anesthesia that this neurosis may disturb the sensorial
as well as the motor functions. This remark is ex-
tremely important, and the sensorial disturbances due
to hysteria constitute a very considerable chapter of
pathology. In this summary review of the great symp-
toms, we cannot follow this disease into the domain of
each perception. Moreover, what will be said about a
particular sense can easily enough be applied to all the
others.
On what sense must we particularly insist? What
are the perceptions on which hysteria determines quite
typical disturbances? We have already spoken of the
tactile sense. Besides, we may remark that disturbances
182
The Troubles of Vision 183
of the tactile sense are not quite separate, that they
are nearly always connected with disturbances of
motion. Remember this old remark of a French doctor
to whom, in my opinion, justice has not been fully
done, Dr. Burcq. "Anesthesia," he said, "never
exists without amyosthenia, that is to say without mus-
cular weakness." No doubt, in certain cases, the tactile
perception may be disturbed only as perception in sub-
jects who need their tactile sense to recognize objects,
but this occurs seldom. You may also observe dis-
turbances of tactile localization, particularly the sin-
gular phenomenon called allochiria, in which the
patient always localizes on his left side what is done to
him on his right side, and vice versa.1
Lastly, you may connect with disturbances of the
tactile sense certain abnormal pains and sensations, but
deliriums always enter into these phenomena, or at
least associations of fixed ideas. No more do I insist
on the senses of smell and taste. They are very often
disturbed in hysteria, but scarcely ever so in an inde-
pendent way. Their disturbances are nearly always
associated with those of the functions of alimentation
and breathing. We shall find them again when we
study the disturbances of the visceral functions.
It would be more proper to devote a lecture to hys-
terical deafness, to disturbances of hearing in these
patients which are often associated with disturbances of
speech, but may also exist separately. Beware of
hysterical deafness; it is frequent and, if I mistake
1 With reference to this problem, see the chapter on Un Cas
<FAttochirie, in my book " Nevroses et Id£es fixes," 1898, p. 234.
184 The Major Symptoms of Hysteria
not, occasions very numerous errors of diagnosis. To
recognize it, with reference to these troubles of hearing
I am glad to indicate to you an interesting study of
Dr. G. L. Walton : " Deafness in Hysterical Anesthesia,"
published in The Brain, 1883. To recognize this af-
fection, remember that it is a central and not a peripheric
deafness. Rinne's well-known experiment will give you
information concerning this first point. When the deaf-
ness is peripheric, when it is due, for instance, to obstruc-
tion of the canal, to a disease of the ossicles, or to a dis-
turbance in the aeration of the drum, the patient keeps
the central audition. You may verify it by making him
hear a watch or a diapason applied to his teeth or to the
bones of his skull. The vibrations propagated through
the bones are still heard, whereas they can no longer be
transmitted by the air. In central deafness it is just
the reverse, and the hysterical disease is connected with
this last group. This being once established, you will
be able to make the diagnosis by studying the motile
and contradictory character of this anesthesia, and by
examining the evolution. I regret not being able to
insist any further on this curious symptom, the study
of which is now beginning to be in fashion. But there
is a sense so interesting from the point of view of
hysteria, and the alterations of which are so characteris-
tic for the comprehension of this neurosis that I want to
devote to it as much time as possible, and it is the rea-
son why our study on the hysterical disturbances of the
perceptions must be, above all, a study on the diseases
of vision.
The Troubles of Vision 185
You know now the general idea that directs us in the
examination of the innumerable phenomena of hysteria ;
it is the idea of dissociation. This disease seems to have
an analytic power; it decomposes the enormous "psy-
cho-physiological system, it separates its functions.
Nowhere is this dissociation more precise and curious
than in the case of vision. The reason is that vision is
a very complicated function, which is subdivided into
numerous operations and which plays a great part in
the mind. Hysteria can effect on it every possible dis-
sociation. First, it may separate at once the whole of
the visual function from the ensemble of the mind;
this is the most radical and the rarest dissociation.
Then it may cause the visual function to crumble, so
to speak, dividing and subdividing it into its elementary
functions, doing away with one and sparing another
with a cleverness that the greatest physiologist might
envy. You even see here an example of the services
that hysteria may render to the physiologist by teaching
him in what way composite functions are decomposed,
which he would be unable to analyze himself.
The first great disturbance, we have just said, is the
dissociation of the ensemble of vision. In other terms,
it is hysterical blindness. This phenomenon is rare, for
it seems that the subject always keeps as much as pos-
sible the essential functions, and loses only a part of
the vision. However, the fact has been very often
established. As long ago as 1618, Lepois pointed out
1 86 The Major Symptoms of Hysteria
this blindness. Since then it has been studied by many
authors, and, in this respect, I especially draw your
attention to the works of the French oculists, such as
Landolt, Borel, and Parinaud. This total blindness
comes on usually in consequence of accidents, and it
belongs to the phenomena of traumatic hysteria.
The following are the two latest cases I have observed.
A man, thirty-eight years old, was busy cleaning a
machine. A rag full of grease and petroleum caught
in a gear and lashed him on the face. The face was
only dirtied, and he did not trouble about the accident.
He washed himself, but he had much difficulty in clear-
ing his skin and eyelids of these fatty substances. Re-
mark that nothing penetrated into his eyes and that he
felt no pain in them. However, after an hour, he seemed
to see as it were a mist before him ; this mist grew thicker
and two hours later he could no longer see at all. His
vision fluctuated a little on the morrow and the follow-
ing days. From time to time he could see a little,
chiefly with his right eye. These fluctuations lasted
for a month, then they disappeared absolutely and for
four years he remained quite blind. Here is a woman,
thirty-one years old, whose story is similar. In a laun-
dry where she worked she received in the face some
water mixed with soap and lime, in consequence of the
explosion of a boiler. Her skin was lightly burnt and
her eyelids swelled. She was in her menstrual period
when the accident happened ; she felt very much agi-
tated and very giddy. During the first days she hardly
dared open her eyes; it was soon noticed that she
could see no more. The amaurosis was complete for
The Troubles of Vision 187
two years. When I examined this patient, there was
already a slight restoration of the vision, which was
easily and rapidly completed. In other cases, the
blindness is less serious ; it lasts a few days and disap-
pears suddenly. A woman of twenty-seven has the
following singular habit ; while reading, she sees, as it
were, a red flash of lightning which illuminates the room ;
she shuts her eyes and, when she opens them again,
she sees no more. Once this accident lasted twelve
days, another time seven, another eight. Her sight
comes back suddenly, just as it disappears.
It is needless to tell you that, when the blindness is
thus complete, the diagnosis is very difficult and that
you cannot take too many precautions. Of course
you must first ask for a thorough examination of the
vision made by a competent oculist. You should beware
of lesions of the fundus of the eye and of the optic nerve,
of hemorrhages of the vitreous body, etc. Inquire into
the state of the pupillary reflexes. Theoretically they
must be quite normal in hysterical blindness; it is a
rule we have already seen. It was so in the three cases
of which I just spoke to you. It is true, you may have
complications connected with the contractures of the iris,
but then do not be in too great a hurry to make a diag-
nosis. Of course you will find a great help in the study
of the mobility of the phenomenon, if you can provoke
it. Sometimes this kind of blindness disappears ab-
solutely in abnormal states, in crises or in somnambu-
lisms; then it is all right. Lastly, you will sometimes
succeed in making the contradictory character evident
and in showing that, in reality, the hysterical can see,
1 88 The Major Symptoms of Hysteria
though she maintains the contrary. Professor Jolly,
of Berlin, said in this respect: "Those children, who
seem not to perceive any light, nevertheless avoid ob-
stacles unexpectedly put before them ; they do not be-
have like people really blind, they must have a kind of
perception." l You recognize in this our subconscious
perception, the establishment of which assumes great
importance here. It is however, true that complete,
hysterical blindness, which happily is rare, is always
very perplexing to physicians.
Happily it is no longer so, when we consider the in-
complete and more frequent forms into which hysteria
decomposes the visual function, doing away with only
one part of it. The simplest and, if I may say so, the
most amusing of these decompositions is unilateral
amaurosis, which is simply grounded on the fact that
man has two eyes and that total vision is a system com-
posed of two visions. Very often you hear young people
complaining that they see only with one eye. They
do not trouble very much, however, about this accident ;
usually, they do not know its origin and have noticed
it by chance. Being one day obliged, for some reason,
to keep their right eye shut, they are quite surprised to
find themselves in darkness. You repeat the experiment,
and you recognize that they see quite well when they
have both their eyes open, but see absolutely nothing
when one of their eyes is shut. These observations
are innumerable and they have given rise to many
studies and discussions about hysteria. It is perhaps
1 F. Jolly, " Ueber Hysteria bei Kindern," Berliner Klin. Wochen-
schr., 1892, No. 34, p. 4.
The Troubles of Vision 189
one of the facts which served as introduction to the
studies of experimental psychology.
The reason is that this amaurosis presented itself
in rather odd conditions and was for oculists an irritat-
ing problem. Why? There is nothing extraordinary
in the fact that an eye is affected separately. It is
because we find here, carried to the highest degree,
the character of hysterical anesthesia. First this
blindness occurs without any appreciable organic dis-
turbance and without any impairment of the elementary
function of the organ. The eye is absolutely uninjured
outwardly and inwardly; its important reflexes are
quite unimpaired. However you may, not infrequently,
recognize a suppression of the reflexes of peripheric
origin; I mean the corneal and conjunctival reflexes.
The touching of the conjunctiva or of the cornea with
a bit of paper, for instance, will not bring on the spas-
modic shutting of the eyelids. We have there a reflex
of superficial sensibility which may be disturbed. But
the pupillary reflexes to light and to accommodation
are mostly perfect, with a reservation of contractures
of the iris, of which I told you to beware. In these
conditions physicians are astonished that the subject
cannot see.
In certain particular cases, their distrust is still more
justifiable, as when, for instance, before the board of
examination for recruits, young men, wishing to avoid
military service, maintain that they are blind of the
right eye and that they are unable to take aim. The
army surgeon charged with the inspection has certainly
a right to express some doubt, when he does not recog-
190 The Major Symptoms of Hysteria
nize any objective disturbance in this eye and sees the
pupil react to light as if the retina perceived quite well.
He invents subtle processes to find out what he thinks
is a fraud. The two prettiest of those processes are
the letters of Snellen and the box of Flees. On an ab-
solutely dark ground are pasted letters cut out of paper,
some blue, others red. To the eyes of the subject is
applied a pair of eye-glasses, one of the glasses of which
is quite of the same blue tint as the letters, and the other
of the same red tint. Through the red glass, which lets
only the red rays pass through, the red letters on the
black ground can be seen, but the blue ones become as
black as the ground and cannot be distinguished from it ;
while the reverse is true for the blue glass. The result
is that, in these conditions, the right eye can read only
one-half of the letters and the left eye the other half.
A person who sees with both eyes instinctively com-
pletes one eye with the other and reads the whole word
without difficulty. In these conditions, a one-eyed
person can only read a part of the letters. Now what
does our recruit do ? With the eye-glasses on his eyes,
he quietly reads all the letters on the black board.
The box of Flees is still more ingenious. Here
(Figure 12) is its schema: the subject looks into a little
box through two holes corresponding to his two eyes,
D and G. At each end of the box are two coloured
spots, two wafers, one red, R, and the other white, B,
for instance. But the subject cannot see them directly,
he only sees their images in two little mirrors, MM, hidden
in the bottom of the box in black paper and making an
angle of 45 degrees with the bottom. These mirrors
The Troubles of Vision
191
cast the images of the wafers sideways, in a strange way ;
the object, which in reality is seen by the right eye, D,
appears on the left side in B, and the object, which in
reality is seen by the left eye, G, appears on the right
FIG. 12. — Schema of the box of Flees.
side in R. Neither, however, of those wafers can be seen
simultaneously by the two eyes. How would a one-
eyed man, who has really lost his left eye, conduct him-
self when asked to look into this box ? He would say :
"I see only one wafer, the white one, B, for instance,
but what astonishes me is that it appears on my left
side ; now usually, I am not able to see on this side."
192 The Major Symptoms of Hysteria
What will a malingerer do who sees with his left eye
but pretends to be blind of this eye ? In reality he will
see the two wafers, but as he will think it necessary to
suppress one, he will of course suppress the one which
appears on the left side, the supposed blind side; he
suppresses the white wafer, B, and he declares that he
sees only one wafer, the red one on his right side.
Now as this wafer, R, can only be seen by the left eye,
which he pretends is blind, the -fraud is discovered.
How do our hysterical patients conduct themselves
in presence of this box ? We must admit that they look
very absurd : Oftenest they naively say that they see
both wafers. You will understand that formerly, in
these conditions, they were generally accused of fraud.
It is strange to remark that our hystericals are not lucky ;
their accidents are such that they are nearly always
mistaken for crimes or tricks. Some were burnt on
account of their fits or devil's claws, others were sent to
prison in order to be cured of their amaurosis.
However it may be, these singular facts discovered by
army surgeons had excited curiosity : there was a time,
especially in France, when the apparently insignificant
little phenomenon of unilateral amaurosis was intensely
studied. With the researches of that period are con-
nected the names of Regnard, Parinaud, Bernheim, and
perhaps also mine, if you will allow me to recall it. To
the preceding experiments many others of much the
same kind have been added. You know the old ex-
periment of the physicist Brewster : if the subject looks
at an object with both eyes open and if you press slightly
on one of his eyes, he sees two objects instead of one,
The Troubles of Vision 193
simply because the object is no longer painted on the
concording points of the two retinas. If, in the same
conditions, without touching the eyes you put a prism
before one eye, the same phenomenon takes place,
the object is doubled. Of course this doubling im-
plies the existence of two eyes and two visions ; nothing
of the kind takes place if the experiment is repeated with
a one-eyed person. You can verify it yourself by shut-
ting one eye and slightly pressing on the other ; the ob-
ject moves, but is not doubled. Well, in the unilateral
amaurosis of hystericals, all these experiments and many
others of the same kind give the same results as with
normal subjects who see with both eyes.
The explanation based on fraud is very simple, per-
haps too simple in the case of persons who are not
recruits and have not the least interest in giving them-
selves out to be one-eyed, and must even pay the oculist
when they take advice. With a more attentive obser-
vation this first interpretation of things was given up.
We have all recorded our word on this question. Of
course M. Bernheim spoke of suggestion. I have my-
self insisted on the subconscious sensations, which con-
tinue to exist in certain cases, though the subject has
no personal perception of them. But now I acknowl-
edge that M. Parinaud has given the best formula of
this special fact. In a pretty disquisition on vision he
showed that the existence of the two eyes and their
position gave birth to two different visions. First, there
is the monocular vision, either separate or alternating,
which is the only one with many animals, as horses,
whose eyes are on either side of the head. They can
194 The Major Symptoms of Hysteria
look to the right or to the left, they can alternate, but
that is all. With animals such as man, monkeys, and
some dogs, whose two eyes are nearly on the same plane,
things are more complicated. These beings may
have not only the preceding monocular and alternating
vision, but also another vision called the binocular
vision. This vision consists in the synthesis of the two
preceding ones, which enables us to see only one object
with two eyes. This vision is an improvement on the
preceding one, in that it allows us to see the same ob-
ject more clearly, permits fixity, and gives the appearance
of relief. It is the starting point of the experiment with
the stereoscope. Generally we make use of this vision,
but we retain the possibility of using the inferior vision,
which we utilize in many cases, sometimes involuntarily
to see sideways, or when one eye is tired, sometimes
voluntarily by shutting one eye when taking aim with a
pistol or looking in a microscope.
Now it is very curious to see that hystericals are able to
effect the dissociation of these two visions, the existence
of which we scarcely suspected. They mostly lose —
and this is an accident that was not known — they
lose the binocular vision, that is to say the higher, truly
human vision. Only they do not complain of it; it
is the medical examination that will reveal to you this
unexpected thing, that an hysterical cannot look with
a stereoscope and is unable to perceive the relief in
Ducos de Hauron's anaglyphs. But sometimes also
they lose the monocular vision of one eye while keeping
the binocular vision. The preceding experiments, by
appealing to the binocular vision, by making it neces-
The Troubles of Vision 195
sary, placed hystericals in conditions in which their
disturbances did not appear. You see that this sin-
gular amaurosis has already dissociated the visual func-
tion in an amusing manner, setting apart now the binocu-
lar, now the monocular function.
II
Let us continue the examination of the hysterical disT
turbances of vision and we shall see that dissociation
will still gain ground and enter into more delicate func-
tions. The most important symptom to be known now
is the famous narrowing of the visual field on which
we ought to be able to dwell for a long time. You know
that human sight, owing to the dimensions of the retina,
extends over a certain surface. The extent of the sur-
face an eye can see simultaneously, without moving,
is called the visual field. No doubt all the points of
this definition should be discussed. It is not quite cer-
tain, in particular, that all the points of the visual field
are seen simultaneously in a single act of attention;
but this definition is practically sufficient. If you
measure the visual field of a normal subject with those
instruments which are called campimeters and perim-
eters, the description of which would be too long, you
obtain the following figure, which I have presented to
you in this picture of the visual field of the right eye,
R, in Figure 13. The field has the form of an irregular
circle, more extended on the external and on the in-
ferior sides, where it measures almost 90°, which means
that the angles formed by the fixation point, the eye
The Troubles of Vision 197
for vertex, and the limit of the visual field, is of 90°.
The circle is narrowed on the internal and superior
sides, where it is barely 60° ; this very natural diminu-
tion is due, as you may guess, to the obstacle formed
by the nose and the eyebrows.
Well, if you examine the visual field of hystericals,
you will recognize a very remarkable fact, which very
likely exists only in this neurosis; the visual field is
narrowed concentrically. The extent of the simul-
taneous vision becomes smaller; the field is almost
circular at 30° or 20°, as you see in the left eye of the
figure 13. Sometimes the field has only 10° or 5°,
and nothing is left but the fixation point. It is true that
a disease of the retina, pigmentary retinitis, and perhaps
also certain forms of chronic glaucoma, give rise to an
analogous phenomenon, but then, in the first place, the
visual field has an irregular form, and, in the second
place, there are visible lesions of the fundus of the eye.
As regards the diseases of the nervous system, it has
been said that this concentric contraction of the visual
field is found in epilepsy and in disseminated sclerosis.
This has been recognized to be false ; so this symptom
becomes one of the most important of hysteria, not for
the patient of course, but for the physician who makes
use of it as a characteristic sign.
This contraction of the visual field has interesting
psychological properties ; it is quite a matter of indiffer-
ence to the subject, and this is a curious fact, on which I
have elsewhere insisted.1 As a matter of fact nothing is
1 " The Mental State of Hystericals," translation into English,
198 The Major Symptoms of Hysteria
so inconvenient as a real contraction of the visual field ;
you know how the unfortunate people who are affected
with chronic glaucoma complain of being no longer able
to glance over their newspaper because they see only
one word or one syllable at a time. These patients, who,
however, see very well in the centre, can no longer find
their way in the street. Hystericals, who have an ex-
ceedingly small visual field, run without in the least
troubling themselves about it. This is a curious fact
to which I remember having attracted the attention of
Charcot, who, had not remarked it, and was very much
surprised at it. I showed him two of our young patients
playing very cleverly at ball in the courtyard of La
Salpetriere. Then, having brought them before him,
I remarked to him that their visual field was reduced
to a point, and I asked him whether he would be capa-
ble of playing at ball, if he had before each eye a card
merely pierced with a small hole. It is one of the finest
examples that can be shown of the persistence of sub-
conscious sensations in hysteria.
Besides, I had shortly afterwards the opportunity
of making a still more precise experiment on the same
point. A young boy had violent crises of terror caused
by a fire, and it was enough to show him a small flame
for the fit to begin again. Now his visual field was
reduced to 5° and he seemed to see absolutely nothing
outside of it. I showed that I could provoke his fit by
merely making him fix his eyes on the central point of
the perimeter and then approaching a lighted match
to the eightieth degree. The same experiment can be
more simply realized by using suggestions, of which
The Troubles of Vision 199
we shall speak later. A subject has received the order,
which he obeys unconsciously, to raise his arm as soon
as he sees a paper before his eyes. The suggestion is
executed even if the paper is put at the eightieth degree,
far out of the limits of his conscious visual field. You
see that this hysterical disturbance has not quite done
away with ocular perception in the lateral parts of the
retina. It is again a dissociation like the preceding
ones. We have two visions, the central vision, which is
accurate and attentive, and the peripheric vision, which
is vacant and of secondary importance. You see that
the hysterical keeps only the first consciously, the second
persisting quite subconsciously.
I cannot end this examination of the visual field
without saying a few words on' a very curious problem
in which I took a particular interest. Can the visual
field be modified only in this way? In other words, is
the contraction always concentric? We have not the
time to examine the different faces of this problem.
I shall only insist on one. Can we meet in hysteria with
the hemiopical visual field or with the phenomenon of
hemianopsia? The question is more important than
it looks. Hemianopsia, that is to say the vision of only
one-half of the visual field, is a frequent phenomenon,
often succeeding cerebral lesions. The section of the
optical nerves, Gratiolet's radiations, the lesions of the
occipital lobes, of the cuneus, do away with the vision
in one of the vertical halves of the retina, and you know
that the lesion is distinguished by the place and form
of this hemianopsia. After some fluctuations, physi-
cians had come, especially after Gilles de la Tourette's
2OO The Major Symptoms of Hysteria
work, to deny absolutely the existence of hysterical
hemianopsia, and to reserve this symptom for organic
lesions. This decision is not tenable a priori. I do not
see any reason why the functional disturbance of
hysteria should not realize the same symptoms as the
organic destruction of the centre of the function.
Every function, as we said when treating of paralyses,
finally has, when it is old, its organic centre, and, in
certain cases, the functional and organic disturbances
may be alike. Besides, did we not unquestionably
establish this fact when we studied hemiplegy? There
is no disturbance more symptomatic of a great lesion
than motor hemiplegy, and nobody denies that it takes
place in hysteria. It is the same with hemianopsia,
and, in despite of theories, we must recognize a fact if
it exists.
After the preceding period of negation, M. De"jerine
in 1894 and I myself in 1895 presented the first authentic
observations of functional hemianopsia.1 I think I
gave the demonstration of the hysterical character of
this syndrome by showing the existence of subconscious
sensations in the apparently suppressed part of the visual
field (Figure 14). Since then I have had the opportunity
to show other equally distinct cases, a schema of which
you see here (Figure 15). In a paper which appeared
in The Brain in 1897, W. Harris presented analogous
cases:2 he pointed out, in particular, as I had done
1 " Un Cas d'Hemianopsie Hystfrique," Lecture at the Salpetriere,
on January 25, 1895, Archives de Neurologic, May, 1895, p. 339, and
in " N6vroses et Idees fixes," I, p. 263.
2 Wilfred Harris, " Hemianopsia with Special Reference to its
Transient Variations," The Brain, 1897, p. 308.
The Troubles of Vision 201
myself, some cases in which hysterical hemianopsia
begins with amaurosis. It is at the time of the recovery
from an hysterical amaurosis that the visual field takes
in many cases the hemianopsic form for some time. I
refer you, with respect to this, to my paper on transi-
tory hemianopsia.1
These phenomena of hemianopsia should not, I
think, astonish us beyond all measure, and induce
us to transform our general conception of the neu-
rosis. The study of the anatomical localization of the
vision leads us to conceive a particular distribution of
vision on the retina. Suppose a man having only
one eye, in the middle of his forehead, like the Cyclops,
or if you prefer it, two eyes placed one under the
other in the middle of his head. Each of these eyes
will have a right half and a left half like the rest of the
body, and a distinct function of the vision to the right
and of the vision to the left will form, comprising the
two right halves and the two left halves of the two eyes.
Later the two eyes separated and disposed themselves
otherwise, but the function has remained the same and
there is still now a function of the vision to the right and
another of the vision to the left. These functions may
become dissociated in hysteria just as all the others;
only, as these functions are very old, the dissociation
seldom goes so far. It exists sometimes however,
and hysterical hemianopsia is a profound accident
which can be compared to motor hemiplegy.
1 " Un Cas d'Hemianopsie Hystdrique Transitoire," La Prase
M&dicale, October 25, 1899, p. 241.
I
3
.9
1
204 The Major Symptoms of Hysteria
111
You can now apply the same method yourselves to
the interpretation of all the other visual disturbances,
which are still very numerous. I will only point out
to you dyschromatopsia, that is to. say, the loss of the*
vision of colours. It frequently happens that hystericals,
while still having a good visual acuity, cease to perceive
colours, or at least certain colours. Violet, blue, and
green seem to vanish first.
Red appears to be the most persistent colour. This
fact was formerly considered as accounting for the
fondness- of hystericals for red. They are fond of
dressing in showy colours, of putting red ribbons in their
hair. The reason is, it was said, that these colours
are the only ones they continue to see. There is some
exaggeration in this, and it is more likely that moral
reasons, such as the very curious need they feel to be
noticed, play a more considerable part in this phe-
nomenon.
I think also that this loss of colours has been examined
with exaggerated accuracy; a visual field of colours
has been drawn, and efforts have been made to prove
that in hysteria this visual field is modified in a regular
manner, the visual field of blue, for instance, becoming
in this disease smaller than that of red. It may be so,
but I advise you to be cautious in this study. First
of all, the perception of colours at the periphery of the
visual field changes very much, even in a normal
person, according to all kinds of conditions and, in
The Troubles of Vision 205
particular, according to the lighting. Besides, in
hystericals, the influence of the association of ideas
plays an enormous part in the perception of colours.
A young woman saw red flowers put on her father's
coffin. It made her very angry, because these flowers
constituted a political emblem; she now holds red in
abhorrence, and has on that account a very fine percep-
tion of red and a visual field for red more extended than
for white. Special account should be taken of the part
played by perceptions and ideas in the dissociation of
the small details of vision, particularly in the accidents
of painful vision, of fears of certain colours, of photo-
phobia, which I merely point out to you.
I wish to insist, before ending this lesson, on some
other accidents, the types of which I must at least in-
dicate to you. These accidents are the disturbances in
the motion of the eyes, about which you will notice as
many complications as about vision itself. Let us not
speak of the movements of the eyelids ; you will again
find here the phenomena of paralysis, tics, contractures,
which we have already studied.
But let us dwell a little on ophthalmoplegy, such as
was pointed out by Lebreton, Ballet, Bristow, and
especially by Koenig in 1891, because it is again an
interesting phenomenon as regards interpretation.
Certain subjects seem to become unable to move their
eyes; they have an absolutely fixed look which seems
strange. Such fixity of the look is often connected
with an automatic fixation of certain objects or with
certain hallucinations. This is the most frequent case,
and when one can divert the subject from his fixed idea,
206 The Major Symptoms of Hysteria
he looks in every direction. But in certain cases, which
have as yet been rather seldom described, it is not so.
The subject looks at nothing fixedly; he can look at
different objects, but only by turning his head; it is
his eyes that do not move. Earlier authors, among
them Morax and Parinaud, showed that this immobility
is purely in connection with the will. If the subject
wants to look sideways, if he is asked to do so, if he
thinks of it, he cannot manage it ; but do not think it
is an absolute immobility, it is sufficient to let an object
fall noisily near him without warning him, and his eyes
will immediately and rapidly turn in this direction. In
a word, here as always, the subconscious and automatic
motion is retained, whereas the voluntary motion is lost.
These disturbances of the movements of the ocular
muscles may be less simple and consist in spasms, in
irregular contractures. Then, of course, the eyes will
deviate in one direction or the other, and you will have
all possible forms of strabismus, the diagnosis of which
is also important. Lastly the disturbance of the ocular
motion may affect the internal muscles, and particu-
larly the muscles of the crystalline lens. Here again,
we have a function that becomes dissociated, that of
accommodation. Instead of being able to accommodate
their eyes to very various distances, from thirty centi-
meters to the horizon, these patients have only a very
limited accommodation. Their eyes are an optical in-
strument in crystal adjusted to a given and immutable
distance. When you find the exact distance to which
they are accommodated, fifty centimeters for instance,
or one meter, an object placed at this distance is seen
The Troubles of Vision 207
quite clearly, but it is no longer seen at all if you put it
nearer or farther. This spasm of accommodation is con-
nected with a great many hysterical disturbances on
which I am very sorry not to be able to dwell : monoc-
ular diplopy, polyopy, macropsia, micropsia, etc. Now
objects are seen double, or triple, and that by a single
eye, which, from the point of view of optics, seems
quite paradoxical. Now they are seen too large or too
small or deformed in a thousand ways. I have de-
scribed in this connection some very odd phenomena : 1
objects appearing to the subject too big or too small in
one of their halves only, and quite normal in the other
— a kind of hemimacropsia.
I shall only point out to you, if not two theses, at
least two tendencies in the interpretation of these odd
phenomena. M. Parinaud and his school sought a
physical interpretation of the accidents in the contrac-
ture of the crystalline lens; others attribute a more
important part to psychological phenomena. You have
here a fine field open to your personal researches. You
see what would be the richness of a study that bears
upon the hysterical disturbances of visual perceptions.
Let us only retain the two following general notions :
First, the disturbance is never very profound, and al-
ways bears solely on attentive and voluntary perceptions.
It always spares the elementary sensations, reflexes,
anatomical movements. Second, the disturbance seems
to consist in a very curious separation of the different
functions united in the vision, which all at the same time,
or each in its turn, separate from personal consciousness
and seem to proceed henceforward on their own account.
1 N^vroses et Id£es fixes," I, p. 276.
LECTURE X
THE TROUBLES OF SPEECH
Importance of the psychological study 0} the disturbances of
speech — Description of some cases of hysterical mutism —
The part played by emotion, by shocks on the right side
— The characters of hysterical dumbness — The for get-
fulness of speech — The absence of paralytic phenomena
— The alleged differences between hysterical mutisms and
organic aphasias — The different forms of hysterical dumb-
ness— Aphonia — Stammering — Aphemia — Agraphia
— A case of hysterical word-deafness — Automatic speech
during hysterical mutism or alternating with periods of
dumbness — Tics or agitations of speech — The emancipa-
tion of the function of speech
As we now know the disturbances of motion and those
of perceptions, we can enter upon the study of a complex
phenomenon, which, in reality, is nothing but a mixture
of the preceding symptoms ; I mean the disturbances of
speech. The function of speech plays a considerable
part in every impairment of thought; it is always
more or less modified in all intellectual disturbances.
However, most mental derangements bear upon a some-
what higher level, upon the formation of ideas properly
so called. On the contrary, hysteria, which bears
essentially upon the voluntary functions of motion, upon
the conscious perceptions, reaches precisely this mental
208
The Troubles of Speech 209
level to which speech corresponds, and must determine
very frequent disturbances in the expression of thoughts.
These disturbances have long been known, but phy-
sicians have generally been inclined to consider them
as being of quite a particular nature. They thought
that hysterical phenomena could not be like others,
and it seems to me that they separated far too much the
disturbances of speech in hystericals from the pathology
of speech in general. I should like to show you that all
the disturbances of speech, whatever they may be, are
to be found in these patients, and that you can study the
pathology of aphasia in them as well as in organic
patients, and even better. Now, when in the papers of
Dr. Pierre Marie of Paris the troubles of aphasia are
brought nearer the disturbances of thought,1 it is in-
teresting to study the hysterical troubles of speech in
which the alteration of the whole consciousness is more
evident.
I
In antiquity certain impairments of speech had al-
ready been noticed, the rapid evolution and the surpris-
ing cure of which seemed unaccountable. The follow-
ing observation made by Hippocrates appears to relate
to a hysterical accident: "The wife of Polemachus,
having an arthritical affection, felt a sudden pain in her
hip, as her menses had not come ; having drunk some
beet-root water^ she remained voiceless for the whole
night until mid-day. She could hear and understand ;
1 Pierre Marie, " La Revision de la Question de 1'Aphasie,"
Semaine Medicale, 1906.
T
2io The Major Symptoms of Hysteria
she showed with her hand that the pain was in her hip."
This description seems to contain everything, the stop-
ping of the menses, the arthritic disturbances, which
are probably disturbances of motion, the preservation
of the perceptions of speech, and the dumbness. It is
not necessary to remind you of the story of Croesus's
son, the dumb young man who suddenly recovers his
speech to cry: "Soldier, do not kill Crcesus."
We may pass on to modern times, and remind you of
all the stories of dumbness in possessed people and
ecstatics. I have already alluded to Carre de Mont-
geron's work on the "Miracles of Deacon Paris,"
in which you can read the case of Marguerite Francoise
Duchesne. After a fit of lethargy which lasted seven or
eight days, there appeared a nearly total loss of voice.
She was deprived of everything, even of the power of
complaining. A month afterwards, she recovered her
hearing and sight, but it was not the same with her
voice, which was never restored to her. In the nine-
teenth century, such cases become more numerous.
The English surgeon Watson boasted of having, through
an electric treatment, restored the power of speech to
a young lady who had been voiceless and dumb for
twelve years. Briquet, Kussmaul, Revillod, Charcot,
and Cartaz insisted very strongly on these phenomena,
which are now well-known in their ensemble.
This accident may happen to confirmed hysterics,
who have already had many accidents of the neurosis,
after a somnambulism or a fit, but they may also happen
to people who have hitherto seemed nearly normal.
It is almost always brought on by a great and somewhat
The Troubles of Speech 211
sudden emotion. It was so, for instance, in the classi-
cal case studied by Charcot. A man of about forty,
living in a little town, had saved some money ; his wife
persuaded him to come and spend it in Paris. He
settled with her in an hotel in the metropolis. One day,
after a short absence, he came back to the hotel and
found that his wife had disappeared, taking the little
hoard with her. The poor man was so upset that he
was deprived of utterance, and remained speechless for
eighteen months. Now, though seemingly cured, he
is still liable to the same accident ; at the least emotion
or fatigue, he loses again the use of speech for a fortnight
or for two months. Notice by the way this character
of hysteria : when an accident has once happened in a
particular and serious form, it is always the same ac-
cident that reappears on every occasion.
The same remark applies to the following observa-
tion which I have noted down : A man who is now forty-
six has been ill since he was twenty. One day at that
period he was in a garden near a glass veranda; a
heavy object thrown from one of the upper floors fell
on the veranda and broke some of the glass with a
noise like the report of a gun. Our man was very
much frightened and remained dumb for two months.
Though twenty-six years have elapsed since the accident,
he never recovered from it ; the slightest noise he hears
suddenly near him, a word spoken somewhat too loud,
is enough to make him dumb again for thirty or fifty
days. In other observations, the dumbness begins
in young women of twenty on occasion of a fire, of the
breaking off of a betrothal, or of a quarrel with their
212 The Major Symptoms of Hysteria
parents. In one case it is caused by the sudden ap-
pearance of a man disguised as a spectre ; the accident
happened when she was eighteen and is not yet cured
at forty-one.
Sometimes the emotion bears particularly on the organs
of speech or respiration : it comes on after a sore throat
or a disease of the chest. In certain cases, one must
not forget that the accidents bore on the right side of
the body. A young man of eighteen fell from horse-
back on his right knee; the consequence was a really
hysterical hemiplegy of his right side and dumbness.
A young woman working in a tavern hurt her right
hand with a broken bottle. She was first paralyzed
in her right side, and this paralysis seemed to extend to
the throat, for she lost the use of speech. These last
cases are important in regard to the association of paraly-
ses of the right side with aphasias. In another curious
case I will remind you of the story of a woman, a great
spiritualistic medium, who, after having too often made
use of automatic writing, was affected with hysterical
dumbness. This again is interesting as regards the
interpretation.
However it may be, when this dumbness is constituted,
it appears nearly always in the same manner of which
Charcot gave a very famous and vivid picture. The
patient, save in exceptional cases, looks healthy and is
not paralyzed. He has not that weak and sickly ap-
pearance of persons struck with an organic hemiplegy
consequent on a cerebral hemorrhage. Nor does he
offer a very visible intellectual weakness, the dazed look
of the latter patients; on the contrary, he seems intel-
The Troubles of Speech 213
ligent and lively. He comes forward with an expres-
sive face, understands all you tell him, but takes a
singular attitude when he has to answer. The charac-
teristic fact is that he does not try to answer; he does
not make those efforts of speech that an aphasic person
makes, or that a foreigner makes when trying to ex-
press himself in a language he knows imperfectly.
He does not look as if he thought it possible to answer
with words ; he does not open his mouth ; he makes no
sound ; he answers with signs, or else takes up a pencil
and answers in writing. In a word, there is no imper-
fect speech, there is no speech at all, and there does not
even seem to be any idea or remembrance or wish of
speech. The subject seems to have forgotten that use
which men, right or wrong, have made of their mouths.
I insist on this character, because all the authors, with
much exaggeration in my opinion, make it a sign of
distinction between organic aphasia and hysterical
dumbness.
When you try to realize the reason of this silence,
which has often lasted for months together, you examine
the different peripheric organs and then notice the second
character of our affection ; namely, the total absence of
paralytic phenomena. The lips, cheeks, tongue, and
soft palate move easily in the most correct way. The
patient, who understands everything, does all he is
asked, moves his lips, bares his teeth, smiles, draws his
lips one way or the other, makes all the movements of
his tongue, and that without difficulty. ' No doubt
I think, in certain cases, some reservation should be
made about this somewhat too theoretical description of
214 The Major Symptoms of Hysteria
Charcot's ; you will very often find in these mutes cer-
tain small localized disturbances of such or such an
organ, for instance slight contractures of some muscle
of the tongue. You must seek for them carefully, for
it is important to do away with them before trying to
bring back speech. You will also remark that the
movements of the lips are not so perfect as Charcot
said : there is no paralysis, properly so called, but there
is often awkwardness, clumsiness, and ugliness. Yes,
ugliness; these subjects, whose mind retrogrades, in
my opinion, lose the delicacy, the perfection, of certain
functions, and you can very well notice their return to
animality from the vulgarity of certain delicate move-
ments. However, I readily recognize that these motor
impairments are slight, and quite inadequate to account
for the enormous paralyses of speech which are to be
observed.
If we go farther, we try to study the condition of the
vocal chords. This study, begun in Charcot's time,
is summarized in the thesis of Cartaz. He recognizes
that, in reality, there is no great disturbance in the vocal
chords. Certain authors have tried to establish a
certain degree of paresis in the adduction, but I fear
they have deluded themselves. The only means we
know to establish the drawing nearer of the vocal
chords is to ask the subject to speak or utter a sound.
Now, as he cannot speak or cry, he does not produce
this movement before us. There is nothing to prove
that the vocal chords are not able to accomplish it, if
it were asked of them. So we are again obliged to
appeal to moral phenomena in order to explain the
The Troubles of Speech 215
hysterical syndrome, and all the authors are obliged to
acknowledge that the disturbance is purely mental.
II
One of the things that, in my opinion, obscured this
study at the outset and brought on many difficulties is
the difference that physicians at once wished to estab-
lish between these hysterical mutisms and the aphasias
accompanied with right-sided paralyses which were
observed to succeed hemorrhages and softenings of the
brain, and whose cerebral localizations were so eagerly
studied in imitation of Broca. Aphasias with destruc-
tion of the third frontal convolution were, it was said,
the true impairments of the psycho-physiological func-
tion of speech; and these aphasias do not present the
same symptoms as hysterical dumbness.
In aphasias, the subject feels that he has lost the use
of speech, and he makes desperate efforts to express
himself. These efforts have some success, for he has
never lost all power to utter a sound; he can give
cries, make varied noises with his larynx; oftenest he
has even retained a few words, which have more or
less meaning, as "papa, come, come . . . macassi;
macassa ..." which he repeats at random, some-
times oddly varying the intonation.
On the other h|nd, the disturbance spreads farther;
a patient who cannot speak at all very seldom keeps
all the other functions of speech intact. He has nearly
always considerable disturbances of writing; he can
no more read, or he reads with difficulty, without
2i6 The Major Symptoms of Hysteria
understanding the meaning of what he spells; lastly,
he does not thoroughly understand the words spoken
before him. These different disturbances, which nearly
always exist in germ in aphasia properly so called, may
develop separately. You know the classification of the
disturbances of speech made in this connection accord-
ing to the predominance of such or such a symptom:
motor aphasias, agraphias, sensorial aphasias with
word-blindness and word-deafness have been de-
scribed. Nothing of the kind, it has been said, is to
be found in hysterical dumbness, which seems to be at
once more extended and more restricted. It is more ex-
tended, for in this case, motor speech is more distinctly
done away with, and the subject does not seem even to
make efforts to speak, as aphasia1 patients do. It is
more restricted, for the disease seems to be limited to
the expression of words and not to impair kindred phe-
nomena, such as writing, reading, and the understand-
ing of words perceived by the ear. So the two things are
different, and as aphasia was considered as the impair-
ment of the function and of the centre of speech, hys-
terical dumbness was necessarily quite another thing.
To these remarks, which I think quite wrong, we
must first answer clinically. Hysterical dumbness,
which I have described to you after Charcot, is a type,
this word being taken in the sense given to it by this
author. It is a particular and striking case, which is
very remarkable from many points of view, but was some-
what arbitrarily chosen. You must not fancy that, all
the disturbances of speech brought on by hysteria are
always conformable to this theoretical model.
The Troubles of Speech 217
We have first to put beside it many attenuated, im-
perfect, or rather incomplete forms, in which the func-
tion of language is analyzed as the visual function was
before. One of the most frequent forms distinguishes
the two degrees of vocal power we have at our disposal.
We have the loud voice with intense sounds, which
enables us to be heard in public, and we have the whis-
pering voice, in which the movement of the lips and
tongue is complete, but in which there is very little
emission of air. Very often in hysteria, the first voice
is lost and the second is kept ; it is what is called apho-
nia. In certain cases, the dissociation is still nicer;
certain subjects can sing aloud and cannot speak ex-
cept in whispers. These distinctions will remind you
of astasia-abasia. In still other cases, there are only
slighter disturbances of speech : the subject can speak,
but stammers, or stutters, or has a special voice more or
less different from his normal voice. I do not insist on
these varieties, because it is more important to study
the varieties approaching the table of aphasia properly
so called.
In my opinion, many hystericals have disturbances
of speech quite identical with those described as suc-
ceeding an apoplectic ictus. Here is an observation I
borrow from the second volume of my " NeVroses et
Idees fixes," page 452. A young woman of twenty, in
consequence of various emotions, shows for a few hours
or days a very singular disturbance of speech, that little
resembles typical hysterical dumbness. First of all,
she is not voiceless, and can make a noise with her
larynx; she even utters cries, either spontaneously
2i 8 The Major Symptoms of Hysteria
or when she is asked. Nor is she quite dumb, for she
tries to speak, which the preceding patients did not do.
She makes with her tongue and lips movements that
produce articulate sounds; but these sounds have no
meaning, and they nearly always consist in the repeti-
tion of a few incomprehensible syllables. If I say to
her: "Miss X., you walk much better to-day," she an-
swers, smiling: " petitbedable, petitbedable, chacha
petitbedable." — To the question: "What happened
to you to-day?" she replies very quickly: "Petitbed-
able, chapetit, petitbedable." We can draw nothing
more from her; she will go on with this "jargonnage,"
as she says, for a few hours. Notice that we have here
a real oblivion of the movements necessary for the pro-
nunciation of words. She is impatient at not being
understood, and seeks to answer by giving different
intonations to her word "petitbedable." It seemed
to us that the intonations were often right, as well as
the expressions of the face, but the words never changed.
Are other functions of speech disturbed ? The audi-
tion of words is not disturbed in the least, she can
understand very correctly all that is said to her. She
reads very well ; I mean that she does all you ask her in
writing, but she is unable to read aloud. As for writ-
ing, it is not totally lost, but there is a phenomenon
that appears to us worthy of remark. The writing has
quite changed; it has become very bad; it is curious
to compare her writing during this state with her nor-
mal writing. You see that the faculty of writing is
markedly diminished, if not entirely lost. How can
we designate these symptoms, if not by the usual words
The Troubles of Speech 219
of motor aphasia or aphemia with a certain degree of
agraphia ?
It is needless to demonstrate here that these symptoms
are hysterical: with such a patient, the demonstration
would be superfluous. Besides, these phenomena will
disappear in a few hours ; we could, if we chose, cause
them to disappear immediately. During the hypnotic
sleep, which is easily induced, the patient will at once
assume a normal manner of speaking. What is more,
as we shall see presently, the subject presents, even
during her periods of disturbance, automatic words,
which she utters during a state of delirium, and which
are quite normal. It is then an altogether hysterical
phenomenon, and yet, as you see, it differs in no way
from an organic aphasia. Such cases might easily
be multiplied.
Besides these cases, you can observe as many phe-
nomena of agraphia as you please. I have already
indicated to you the loss of writing as one of the possible
forms of systematic paralysis. Charcot already pointed
out some such cases in his "Le9ons du Mardi," l Lepine,
Ballet, Sollier published some, I observed several.
You may even observe some curious forms, in which
the writing becomes again childish and is quite like old
writing books of the patient.
Can we go further? Do there exist in hysteria
word-blindness and word-deafness? For my part, I
am convinced of it, and I do not see why this dissocia-
tion should not take place when all the others do. It
must be acknowledged, however, that cases of this kind
1 T. M. Charcot, " Lejons du Mardi," p. 367.
22O The Major Symptoms of Hysteria
have seldom been published. I therefore recommend
to you to study an observation that in my opinion is
important, the one which concerns a young girl called
Rachel, and which I published in the second volume of
my book on " Neuroses and Fixed Ideas." ' The obser-
vation and the discussion are too long to reproduce here.
I only point out the principal points. A girl of nineteen
has a strange bearing. As soon as we speak to her, she
looks embarrassed ; she does not answer, moves on her
chair, moans, and at last says: "I do not understand,
I cannot understand." At first sight it looks as if
she were deaf ; that is, moreover, the dominant opinion
entertained about her in her surroundings. Yet this
opinion is not right. If you make a noise behind her,
she almost always turns round. Curiously enough,
if you put a watch near her ear, she declares that she
hears ; you may thus recognize that she hears the tick-
ing of the watch at sixty centimetres on the right and
at forty on the left. The hearing of this girl was very
carefully examined by M. Gell£ two different times.
His conclusions were always the same and quite defi-
nite; this patient is not deaf by any means; all we
can say is that there is a slight diminution of the audi-
tory acuity, especially on the left. There is no appreci-
able lesion of the external auditory apparatus.
But then why does not this patient answer us?
Because, as she says herself, she does not understand.
Though she hears our words, they have no meaning
for her. It is the same with musical airs. She hears
them very well, but she does not recognize, does not
1 " Ne*vroses et Id£es fixes," 1898, II, p. 456, Observation 134.
The Troubles of Speech 221
understand them. In a word, it is the syndrome well
known under the name of word-deafness. In the
present case, this word-deafness is quite complete.
The patient has also completely lost the functions that
appear to depend on word audition. She is quite in-
capable of writing from dictation, and of repeating,
even without understanding them, the words spoken
before her. They are noises, she says, and she does not
know how she could manage to repeat them. The
disappearance of that connection between sounds and
movements has often been noticed in word-deafness.
If the word-deafness is complete, it is none the less very
isolated, that is to say, all the functions of speech save
the audition of words seem to have remained quite
intact.
Now what are the diagnosis and origin of this clini-
cally incontestable word deafness? They are most
strange. A few years ago, this already impressionable
and nervous girl was being educated in a convent. At
the age of twelve, she had a typhoid fever, and remained
weak and nervous, though still intelligent and free
from any disturbance of speech or hearing. A short
time afterwards, she began to present odd symptoms,
about which, unfortunately, we have quite insufficient
information, for they were only observed by the nuns
of the convent. The child had a disposition to fall
asleep in the middle of the day, especially between
one and four in the afternoon. These sleeps were
sometimes complete and very deep, nor could anything
awaken the sleeper, who did not even feel prickings
made in her arm. On other days, the sleep seemed
222 The Major Symptoms of Hysteria
less profound, since the child kept her eyes open and
went on with her sewing. But she did not answer,
could not be disturbed, and, on awaking, would say
that she had done nothing and was surprised to see her
work getting on. This is all we know about those
sleeps, which lasted for nearly two years with the same
characteristics. One day the nuns became incensed
at these continual sleeps and punished the child, but
it was of no use. The chaplain was sent for, and it was
demonstrated to her, in a fine exhortation, that if she
slept again, she should first be shut up in a dark room
and later on, go to hell. The little girl was frightened
and swore that she would sleep no more. When the
hour of her usual sleep came, she contrived, through
desperate efforts, to remain awake. It is impossible
for us to know exactly what happened. Rachel asserts
she had no convulsions, went on with her sewing, but
felt her mind confused and her head, as it were, clogged.
Moreover, her recollection in this respect is very
vague.
However it may be, after a few hours' discomfort, she
realized that she was no longer sleepy at all. When she
was spoken to, she did not answer, and her features
assumed a dazed expression ; every endeavour was used
to rouse her, but it was soon noticed that she understood
nothing and answered very badly. What was exactly
the extent of the disturbance at the outset? Our in-
formation is insufficient ; it seems certain that there was
no paralysis, but it seems that speech was disturbed as
well as hearing. However it may be, the disturbance of
speech did not persist. After a few weeks, she spoke
The Troubles of Speech 223
correctly, as now ; she had only a somewhat odd accent ;
but the hearing of words made no progress. She re-
mained, as at the outset, incapable of understanding
anything.
No doubt, all this is not very definite, and we may
wish to find, later on, more distinct observations of hys-
terical word- blindness and word-deafness. However,
these sleeps, these somnambulisms, the neuropathic
disturbances which still persist, the total absence of
any symptom of cerebral lesion or lesion of the ear,
seem to prove that the disease approaches the great
neurosis.
These observations, which could easily be multiplied,
show you distinctly enough, I think, that, besides the
classical and typical hysterical dumbness, there are all
kinds of forms of this affection, and that some of these
forms are quite identical with what is understood under
the name of aphasia. So there is no opposition be-
tween those two groups of symptoms; the hysterical
dumbness of Charcot is nothing but a more sharply
differentiated, more isolated form of the disturbances
of speech. The subject loses absolutely the power of
speaking, and loses only that. He loses that power
so entirely that he forgets it and does not regret it, so
that he has no longer even the idea of the efforts to be
made. This we already saw when studying hysterical
paralyses and anesthesias. It is, therefore, very likely
that the function of speech is also disturbed in the
same manner in all those organic and neuropathic ac-
cidents.
224 The Major Symptoms of Hysteria
III
To understand the impairment of this function of
speech, we must rapidly make some remarks which you
already know. Let us take up again the observation
of the hysterical who to all the questions put to her
could only reply with the words : " chacha petitbedable."
Often, in the midst of this state of aphasia, the patient
had kinds of reveries or deliriums, in which she expressed
aloud, either fixed ideas which preoccupied her, or
conversations she had just had, in which she put the
questions and made the answers herself. In all those
slight deliriums, she spoke very correctly, either in
French or in English, and there was no trace of aphasia
left. Observe that, in all those chatterings, ' she said
things she regretted later on, expressing her secrets
aloud. They were quite involuntary words. If you
interrupted her, if you attracted her attention to ask
her to reply to a question you put her, she listened,
tried to speak, and no longer said anything but "petitbe-
dable." In a word, there was aphasia in conscious and
voluntary speech, and the normal expression of ideas
reappeared only in the deliriums and automatic speech.
This fact is more general than is commonly believed.
In patients affected with dumbness you may often recog-
nize, in the period of dumbness itself, that normal
speech reappears during the crises, the somnambulisms,
the dreams. Oppenheim indicated some facts of this
kind, Gilles de la Tourette describes a dumb patient who
speaks during her dreams.
The Troubles of Speech 225
^
More often still those automatic and irrepressible
words do not coincide exactly with the period of dumb-
ness, but present themselves in the same patients be-
fore or after this period. We then find in these sub-
jects crises of irresistible chattering, to which we already
alluded in connection with somnambulisms. Some-
times these crises come on during a sleep or an ab-
normal state, but often they take place while the patient
is awake, and then he listens in astonishment to the
words he speaks. Read again, in the history of the
Camisards in the seventeenth century, the anecdotes
relating to the lesser prophets of the CeVennes, and to
the most celebrated among them all, Elie Marion. He
felt himself, as it were, seized by the Lord, he could no
longer dispose of his voice, or speak voluntarily, he
did not know what his mouth was about to utter, and
was quite surprised at hearing the fine discourses with
which the Holy Ghost inspired him. This verbal
automatism should be placed beside the automatism
of writing in the spiritualistic medium. He also feels
that his hand escapes his control and is no longer ruled
by his will ; he is quite surprised at seeing what his hand
has written. It is a phenomenon of the same kind.
With the same group are also to be connected the
tics of speech, which are numberless in the form of
coprolalia, echolalia, etc. You will find a very good
description of them in the little book of M. Seglas on the
disturbances of speech. I should be inclined to go
even further and to say that many verbal hallucinations
of inner words are phenomena of the same kind, though
somewhat less marked. In all these facts, the function
Q
226 The Major Symptoms of Hysteria
of speech, which is by no means destroyed, seems to
escape the conscious will of the subject. Inwardly or
outwardly, he speaks in spite of himself and without
any participation of his self : it is a mechanism which
has emancipated itself.
Well I believe that for this fact as for the preceding
ones, this symptom of agitation, of automatic function-
ing of the function, should be placed beside the paralysis
bearing on the same function. They are two parallel
and concomitant phenomena. One more example
occurs to me. Bes. had very varied crises in the
hospital. After her ordinary crises, in which she had
cried to exhaustion, she retained perfectly the power of
speaking. But she had special crises in which her
speech seemed, as it were, to be thrown out of gear,
in which she chattered in a low voice with extreme
volubility. After these crises she always awoke dumb ;
the emancipation of speech brought on dumbness.
This we have already seen in the somnambulism that
brings about amnesia, in chorea and in the tic that
brings about paralysis.
Here again everything happens as if the system of
the movements and images that constitute speech
separated from the personality and functioned apart
in an automatic, and at the same time inferior, and, as
it were, degraded, manner.
LECTURE XI
THE DISTURBANCES OF ALIMENTATION
Visceral troubles — Hysterical anorexy — The description
oj its three periods : the gastric period, the moral period,
the period of inanition — The frequent termination by
death — The theory of the fixed idea — The diagnosis
with the psychasthenic refusal of food — The theory of
anorexy through the anesthesia of the stomach — The
part played by anesthesia in the modifications of the feeling
of hunger — The motor agitation of the patient — The dif-
ferent explanations of this fondness for physical exer-
cises — The suppression of the feeling of fatigue and the
motor excitation — The psychological function of alimen-
tation — The hysterical dissociation of this function —
The dissociation of the elements of this junction — The
paralyses of the lips, tongue, pharynx, oesophagus, abdo-
men — The troubles of the function of the bladder
AFTER passing in review the mental disturbances of
hystericals, their sensory and motor disturbances, we
shall now enter upon a rapid survey of their visceral
disturbances. These patients, in fact, seem to present
great impairments of the visceral functions, especially
of the functions of digestion and respiration. These
visceral phenomena have always greatly puzzled physi-
cians, and nowadays they are still often opposed to
those who want to give a mental explanation of this
disease. We must, therefore, insist on their interpreta
227
228 The Major Symptoms of Hysteria
0
tion. To penetrate into the study of the mental dis-
turbances of hysteria, we shall begin by studying a very
important phenomenon, that of anorexy, which by
its character, at once physiological and mental, will
furnish a transition between these new studies and the
preceding ones.
I
The words "hysterical anorexy" designate a disease
both mental and physiological, very long and very com-
plicated, which consists chiefly in the systematic refusal
of food, in certain digestive disturbances, and in a con-
sequent inanition. This odd phenomenon was for a
long time very ill known; it was confusedly ranged
among the other manias of those patients, and their
strange way of living without eating was often ascribed
to the action of the demon or to that of God.
Its accurate description is recent ; it was made almost
simultaneously by W. Gull, in 1868, and by Lasegue
in 1873. The article of Lasegue was the only one that
had success and contributed to spread this new medical
notion ; it led Gull to observe in 1873 tnat ^e nad already
indicated these facts in 1868. The English physician
called this disease "apepsia hysterica"; Lasegue
named it "hysterical anorexy." Neither of these two
appellations is perfect ; the absence of pepsine, which,
moreover, is doubtful, has nothing interesting in it
here ; the loss of appetite is more important, but it is not
certain that it is the essential characteristic. There-
fore, some subsequent authors, wishing to emphasize
the capital fact, which is the systematic refusal of food,
The Disturbances of Alimentation 229
made use of the words "sitiophobia," that is to say,
aversion to food, and "sitieirgia" (a-inov etpyat),
food repelling, that is to say, rejection of food ; or even
of the words "hysterical inanition" which Lasegue had
also proposed. The last words are evidently better,
but usage, which is a great master, has not accepted
them and has even employed them differently. It has
retained the term hysterical anorexy. It is enough if
we understand one another.
This accident may happen in the course of hysteria
after many characteristic phenomena, which will serve
for its recognition. Oftenest it forms the outset of
hysteria and its real nature is only recognized late.
Many cases have been cited in adult and young men,
but it cannot be denied that it is infinitely more frequent
in women. A case has been cited at the age of eleven
(Kissel) ; I have observed one in a little girl of nine ;
it has also been recognized in a woman of thirty-eight.
Lately I studied a very distinct case in a woman of
forty, but it was an old accident which reappeared.
It must be acknowledged that these ages are quite
exceptional ; the greatest number of cases by far — nine
out of ten — are to be met with in girls of sixteen to
twenty-three or twenty-five at most. It is one of the
facts of the special pathology of the girl of eighteen.
You should never forget it when in presence of a
patient of this age.
That affection which seizes the girl of eighteen is a
chronic one. It is a disease that never lasts less than
eighteen months to two years, and often continues for ten
years. The result is that it goes through different periods
230 The Major Symptoms of Hysteria
which Lasegue reduced, rightly enough, to three prin-
cipal ones.
The first period might be called the gastric period,
for everybody fancies that the disease consists simply
in an affection of the stomach, and behaves accordingly.
The beginning, which it is not always easy to know,
often coincides with a slight, more or less real, affection
of the stomach. More often it is again the consequence
of an emotion. Mu., for instance, a girl of nineteen, of
whom I often think when speaking to you of anorexy,
presented her first gastric disturbances after the death
of her brother, who succumbed rapidly to pulmonary
phthisis. The patients complain of various and vague
sufferings, which they connect with their digestion.
Then come consultations on consultations and, of course,
a lot of absurd diagnoses and ridiculous medicines. It
is thought quite natural that the girl, whose stomach
is diseased, should be careful of what she eats; her
medical attendants would even be inclined to prescribe
to her a still stricter diet. She resigns herself to every-
thing and shows herself a patient of exemplary docility ;
moreover, save for vaguer and vaguer pains in her
stomach, she seems to enjoy perfect health ; her tongue
is clean, her stomach and abdomen normal; the only
thing she may suffer from is obstinate constipation.
Usually, after a long time, begins the second period,
the moral period, or period of struggling. The family
at length become disquieted at the indefinite prolonga-
tion of these treatments and ultra strict diets, which
do not seem very well justified. They suspect hypo-
chondriac ideas and obstinacy, and their attitude be-
The Disturbances of Alimentation 231
comes quite modified. Now they try to allure the pa-
tient by all possible delicacies of the table, they scold
her severely, they alternately spoil, beseech, threaten
her. The excess of the insistence causes an exaggera-
tion of the resistance ; the girl seems to understand that
the least concession on her part would cause her to pass
from the condition of a patient to that of a capricious
child, and to this she will never consent.
All the relatives and friends interfere by turns to
try what their authority and influence may do. Lasegue
has well described those distressed families who, all day
and to the first comer, speak mournfully of the girl's
food. It's all of no use, the disease develops more and
more under the influence of these surroundings. Now
the girl scarcely ever speaks of her pains in the stomach,
but she repeats that she will eat when she is hungry and
that she is never hungry, that she does not need more
food, that she can very well live indefinitely in that
way, that, moreover, she has never felt better. In
fact she seems to be in very good health and shows
much strength and activity. She has even a greatly
exaggerated physical and moral activity, to which we
shall have to revert, for the fact is very important.
Supported by this conviction, our strange patient
struggles with all those around her, by every possible
means. She seeks a support in one of her parents
against the other, she promises to do wonders if her
family is not too exacting, she has recourse to every
artifice and to every untruth. It is the period when such
patients hide victuals in their pockets, fill their cheeks
and throat with them, to go and spit them out in the
232 The Major Symptoms of Hysteria
lavatory, when they learn to vomit immediately what
they have just swallowed, etc.
Lastly comes on, sooner or later, but sometimes
only after years, the third period, called period of inani-
tion. Organic disturbances begin to appear, the breath
is foul, the stomach and abdomen are retracted, there
is an insuperable constipation, the urine is scarce and
contains little urea — only 3 grammes instead of 30
grammes with one of my patients. The skin becomes
dry, pulverulent, and in certain places, as on the wrists
and forehead, cracked and covered with pimples. The
pulse becomes very quick, between one hundred and
one hundred and twenty, the breathing is short and
hurried, you hear cardiac and arterial breaths. Lastly,
the extenuation, which the parents best observe, makes
surprising progress. It is a clinical fact which one
must well remember, that weight is not a reliable
sign of the progress of the disease ; for, after a rather
great decrease at the outset, it is only at the end, and
often too late, that it falls suddenly.
Matters have changed, then. The patients who no
longer leave their beds remain in a semi-delirious, semi-
comatose condition. At this stage they behave in
two different ways ; some continue to be delirious, and,
as Charcot said, have but one idea left ; namely, to re-
fuse to eat. Others, fortunately, begin to be frightened.
That was what Lasegue expected ; because of a singu-
lar therapeutic dignity, he judged that the physician
was not justified in .doing anything before. At that
moment he resumed his authority, and according as
the patient yielded completely or partially — which
The Disturbances of Alimentation 233
latter case was the more frequent — he cured her
more or less completely. In fact, the hysterical is
privileged in this respect. You know that the dog
cannot be called back to life when it has lost forty
per cent, of its weight; the hysterical can still be
saved at fifty and above. There is a limit, however.
Out of his eight cases, Lasegue had not one death;
the number of deaths since then cannot be numbered.
I know three, for my part. It is the melancholy period
when those poor girls ask to eat and it is too late. It is
true that things generally take another turn, and an
intercurrent disease comes on, broncho-pneumonia
or almost phthisis, which simplifies the situation.
Such is the general history of this strange mental
disease. Its gravity, its frequency, the regularity of
its evolution, whatever may be the intelligence of the
subject, show that it is due to a deep psychological
disturbance, of which the refusal of food is but the outer
expression.
II
This disturbance of thought is fairly well known in
its details and evolution, but it is certainly very difficult
to interpret, and various theories of anorexy give the
preeminence to one or the other of the essential phe-
nomena.
Lasegue, and later on Charcot, gave the preeminence
to a delirious disturbance, to a fixed idea. The disease
consists essentially in an idea of which the patient is
perfectly conscious, though she often conceals it, and
which has for consequence the voluntary and calculated
234 The Major Symptoms of Hysteria
refusal of food. Some are over anxious about their
stomach, apprehend the pains provoked by digestion,
or simply fear the sensation of a ball in their oesophagus.
Others have scruples, regret to eat the flesh of living
animals, are ashamed to eat when too many poor people
have not sufficient food. I knew a girl of eighteen who
died in consequence of her abhorrence of turnips,
which she had contracted when at school. To the end
she refused to eat anything, saying that everything smelt
of turnips. Very often, they simply have the common-
place idea of suicide: for some reason or other these
girls make up their minds to die because of a thwarted
marriage, a reproach, for having quarrelled with a friend,
etc. And, in their innocence, they adopt starvation
for their mode of death, judging it to be a simple, clean,
not very painful process, which will arouse nobody's
suspicion. The following observation of Charcot is
famous: while undressing a patient of this kind, he
found that she wore on her skin, fastened very tight
around her waist, a rose-coloured ribbon. He obtained
the following confidence; the ribbon was a measure
which the waist was not to exceed. "I prefer dying
of hunger to becoming big as mamma." Coquetries
of this kind are very frequent; one of my patients
refused to eat for fear that, during her digestion, her
face should grow red and appear less pleasant in the
eyes of a professor whose lectures she attended after
her meals.
The authors who have observed such ideas seem to
me to be inclined to exaggerate their importance.
This is what certainly happened to Charcot, who used
The Disturbances of Alimentation 235
to seek everywhere for his rose-coloured ribbon and
the idea of obesity. I believe there is on this point a
diagnosis to be made, on which I have much insisted
in the first volume of my work on obsessions. Refusals
of food are not always a phenomenon of the hysterical
neurosis; they belong at least as often to the psychas-
thenic neurosis. It is in the latter neurosis that fixed
ideas remain alone and play a predominant r61e to the
end.
These patients will be recognized by the absence of
other psychological disturbances associated with the
fixed idea. In particular, they have no real anorexy;
they have retained the feeling of hunger ; and they often
submit to veritable tortures in order not to yield to
their need of food. These patients make it a point of
honour not to yield, at least before others, and this
accounts for an odd fact often indicated in their history.
After having all day refused the food offered to them,
they get up at night secretly and steal dirty victuals,
so that one must always be careful to leave food within
their reach. As they have no real loss of the feeling
of hunger, so they have no real anesthesia, either in
their mouth or in their epigastrium; lastly, they do
not present that excessive need of movement, the im-
portance of which I have already indicated in real
hysterical anorexics. In the latter, in fact, the fixed
idea, which existed at the outset, it is true, and played a
certain r61e for a while, becomes complicated with very
serious phenomena, as the loss of appetite, the anes-
thesia of various organs, certain phenomena of system-
atic paralysis of the acts relating to alimentation, and
236 The Major Symptoms of Hysteria
the great motor agitation. I believe therefore that one
should distinguish real hysterical anorexy from those
refusals to eat brought on by various obsessions, and
in particular, by obsessions of scruples in various psy-
chasthenics.
Therefore, other theories tried to take these new
phenomena into account, and this is done in particular
by a theory which is nowadays pretty widespread, the
theory of anorexy through the anesthesia of the stomach.
Besides the anorexics due to delirious ideas relating to
illness, to pudicity, to obesity, it has been asked whether
there do not exist anorexics brought about by disturb-
ances of the organic sensibility. They would then
justify their name and be above all losses of the sensa-
tion of hunger. This already old thesis, which was
indicated by magnetizers, such as Despine in 1840, has
been chiefly developed through studies on metallo-
therapy carried on especially by Burcq, 1875-1882.
Since then, it has been systematized and exaggerated
by Sollier. "Anesthesia," Burcq once said, "exercises
a preponderant influence on all the other symptoms,
in particular on the disturbances of alimentation and
on the secretions." His great argument was that he
could cause these anesthesias to vanish through the use
of the metallic plates and armatures he had contrived,
and that he then saw the hysterical phenomena, anorexy
in particular, disappear.
There is much truth in these remarks. First of all,
we must recognize in anorexy, when already well
settled, and of decidedly hysterical nature, the exis-
tence of numerous anesthesias. They are observed
The Disturbances of Alimentation 237
in the mouth, on the tongue, on the internal face of
the cheeks, in the oesophagus. At the same time may
be noted the absolute anesthesia of the special senses of
taste and smell. You know that the patients, especially
at the outset of their disease, want to have raw aliments,
and ask for salt and vinegar in order to give some taste
to their food; and that, later on, they complain that
they are given sand or earth to eat. You also know
that some of them do not feel the food in their mouths.
It is not rare to observe at the same time the anesthesia
of the lower part of the digestive tube, of the anus, and
of the rectum. The anesthesia of the stomach itself
and of the small intestine is the more difficult to estab-
lish, as the sensibility of these organs is commonly
very obtuse, but it is highly probable. Many subjects
do not feel too hot or too cold food descend into their
stomachs. Moreover, you have already seen a very
curious law, indicated by M. Gilles de la Tourette,
namely, that often, in hysteria, superficial anesthesia
of the skin accompanies the anesthesia of the organs
placed under it. Now, in hysterical anesthesia, a
patch of cutaneous insensibility is often recognized,
seated just in the epigastric region. It is probable,
therefore, that the mucous membrane of the stomach
is as anesthetic as that of the mouth.
Do these various anesthesias, seated in all the parts
of the digestive tube, play a rdle in the disturbances of
the functions of alimentation? The thing seems to
me very likely. The fine studies of physiologists, in
particular those of M. Pawlof, have shown that the
saliva secreted by a dog varies with the object presented
23 8 The Major Symptoms of Hysteria
to him, with the taste and smell of that object. They
have shown that the secretions of the stomach and of
the intestine were in connection with the sensation of
the food in the various parts of the digestive tube.
Since these patients feel neither taste, nor smell, nor
any excitation of the mucous membrane of their stomachs,
it is very likely that their digestion will be disturbed. A
physician even tried to go still further. You know
that the anesthesias of hystericals are mobile, that it is
possible, through various processes, to cause them to
disappear and to reappear. This physician thought
he recognized, at least in one case, that the secretion
of the gastric juice was very different, according as the
subject felt or did not feel in his oesophagus and in his
stomach.
From these remarks results a new conception of the
disease. It is the gastric anesthesia which is here the
great culprit. While the sensation of the movements
and of the secretions of the stomach is the starting point
of the feeling of appetite, the immobility and insensibility
of the stomach bring on complete anorexy and all the
delirious ideas, which are considered here as secondary.
There is some truth in this conception, but it does
not seem to me to be complete. First of all, the anes-
thesia of hystericals is never complete, and does not do
away with the reflexes. We have already studied this
point. If food is introduced by force with the sound
into the stomach of the most anorexic hysterical, if you
prevent immediate vomiting, you will recognize that the
digestion, perhaps somewhat slow at the beginning,
comes to be completely effected and in the most normal
The Disturbances of Alimentation 239
way. This M. Henry Francais has just shown again in
his thesis on " Apepsy," which he maintained this year.
So psychic insensibility does not play here a consider-
able material part. Supposing the anesthesia of the
stomach should do away with appetite, it would not
make the patients incapable either of eating or of di-
gesting.
In my opinion, an exaggerated importance is ascribed
to the r61e played by these local phenomena of the mouth
and stomach in the general feeling of hunger and in the
function of alimentation. Animals that have been
deprived of their stomachs still try to feed. We do
not always need a perfectly marked appetite to eat.
We often accept food out of politeness, in mere imitation
of others, or because we think it reasonable, when we
do not really wish for it. In a word, these authors are
right in adding more elementary and more general
disturbances to the fixed ideas of hystericals. They
are wrong in stopping in this matter at the sensibilities
of the mouth and stomach.
I wish a more thorough investigation might be made,
in this connection, of a phenomenon that is as yet very
imperfectly elucidated ; namely, the excessive fondness
for physical exercise that characterizes a whole group
of anorexic patients. This character was already
noted by Lasegue. It is well indicated in a short and
unfortunately very incomplete article of Dr. Wallet.1
"The patient," he says, "is exceedingly fond of long
walks. As she is growing thinner with enormous
1 Wallet, " Deux Cas d'Anorexie Hyste*rique," Nouvelle Iconth
graphic de la Salpetrtire, 1892, p. 276.
240 The Major Symptoms of Hysteria
rapidity, they are forbidden to her. She then begins
to walk, from morning to night, up and down the little
garden of the house, which was likewise forbidden to
her. Then she plays all day at shuttlecock. It is
prescribed that she stay in her room; there she gives
herself up to violent gymnastic exercises. Even in
bed she goes on with her gambols and summersaults."
For my part, I was much struck with this odd phe-
nomenon, which most authors merely indicate, without
dwelling upon it. One of my patients, Mu., has had
for years a mania of walking of at least as great gravity
as her mania of refusing to eat. She must needs go
every day on foot as far as the Trocadero and the Bois
de Boulogne. The carriage has only the right to
follow her. She tires the persons who accompany her.
If a limit is fixed of two hours' fast walking a day,
she makes scenes about the calculation of the minutes.
No supplications or menaces can stop her walking, any
more than they can stop her inanition. With a very
singular woman, who has periodical anorexics conse-
quent on the least emotion, the need of walking begins
immediately with the refusal to eat. It happens
suddenly; after the emotion, she refuses to return
home, as well as to dine. This character is at least
as strange as the first.
The first explanation of this fact was presented by
Lasegue and by Charcot, and since then it has always
been repeated without hesitation. These patients walk
too much and take too much exercise by virtue of a
piece of reasoning: they want to make those around
them believe that they are still strong and robust, in
The Disturbances of Alimentation 241
order not to be compelled to eat more. I confess
this explanation does not satisfy me. Many patients,
who spoke to me sincerely during or after their disease,
have assured me that they thought nothing of the kind.
Moreover, this exaggerated motion is to be found in
aged patients who are left at liberty and whose alimen-
tation nobody watches over.
Another curious explanation is that which was given
by M. Wallet in 1892. The patient walks in order to
grow thin, in order to compensate with the exercise he
takes the alimentation that is imposed upon him. With
this explanation^ we return to the initial idea of Charcot ;
namely, that all these patients want to grow thin. You
know that it is not true, and that if in some particular
cases this exaggeration of motion can be explained by
such reasoning, it would be absurd to generalize the
explanation.
I believe that the phenomenon in question is much
more important and serious than these authors thought.
It is not the result of a little particular imposition ; it
is connected with a very general disturbance. This
disturbance first comprises the suppression of the feeling
of fatigue, which is here much more important, in my
opinion, than the anesthesia of the stomach. It com-
prises, besides, something that is very little known;
namely, a general excitation to physical and moral ac-
tivity, a strange feeling of happiness, an euphoria,
according to the medical term, which are certain but
very little studied facts. The need of food goes with
the feeling of weakness and depression; persons de-
pressed by neurasthenia are great eaters. The exal-
The Major Symptoms of Hysteria
tation of the strength, the feeling of euphoria, as it is
known in the ecstatic saints, for instance, does away
with the need of eating. Our hysterical anorexy is to
be traced to much deeper sources than was supposed.
This is how I propose to you to represent it to our-
selves, without, however, pretending to explain it. The
function of alimentation, if we consider it on its psy-
chological side, is one of the most considerable systems of
thoughts that exist in the brain of an animal. It com-
prises fundamental phenomena, such as the feeling of
weakness, of depression, and the fear of death. Besides,
it comprises numberless secondary phenomena, such as
the sensations and motions connected with all the parts
of the organism that play a r61e in alimentation, from
the hands, lips, and tongue to the rectum and anus;
lastly, it also comprises phenomena of improvement,
as the images of pleasant aliments, the habits of eating
cleanly, and the mixture of certain social phenomena
that usually complicate our alimentation. There is in
the hysterical a dissociation of this system, which may
totally or partially withdraw from consciousness. In
complete anorexy, you will find the loss of all the ele-
ments I have just described, the loss of the sensation of
weakness, replaced by a pathological euphoria, the loss
of the sensations of the organs, but also, more than is
generally believed, the loss of the movements. These
patients can no longer cleanly convey their food to their
mouths, they can no longer masticate, and above all,
they can no longer swallow, nor can they go to stool.
There is, besides, a phenomenon which has not been
much noticed and which consists in losses of the social
The Disturbances of Alimentation 243
ideas of alimentation. Marceline was very amusing
when she explained to me how ridiculous she thought
the act of eating, how much she wondered to see people
gather for this dirty operation. Hysterical anorexy is,
at bottom, a great amnesia and a great paralysis. Ali-
mentation has become, as it were, a somnambulistic
phenomenon which can only be effected in the second
or somnambulistic state, as happened with the last
patient. This phenomenon is lost to the normal and
waking consciousness.
Ill
Before concluding this lecture, I should like rapidly
to add a few details, which it is necessary that you should
know, but to dwell on which would take too long.
The dissociation of which I have just spoken to you
may bear on all the elements of which the function is
composed, and suppress them separately. You have then
kinds of paralyses or amnesias, as you choose, which
may be connected with all sorts of organs. It is need-
less to enumerate them; you have only to follow the
organs themselves. The hysterical patient may lose
the functions of the lips in alimentation, as she lost them
in speech. She may lose the functions of the tongue
or those of the teeth.
Grant a little more attention to the functions of
deglutition of the pharynx. Many of these patients can
no longer swallow, and they should not be confounded
with psychasthenics, who have the phobia of deglu-
tition. Some of these subjects cannot make their food
244 The Major Symptoms of Hysteria
pass from their oesophagus into their stomach. I am
attending an old hysterical lady, and do you know what
my first care must be when I see her after her lunch?
It is to make her swallow her lunch, which she still
has in her oesophagus. I am sure that the amnesia of
defecation plays a r6le in many obstinate constipations.
What happens for the intestine is still more important
and frequent for the bladder. You know that hysteri-
cals may lose all the functions of the bladder or only
some part or other of them. Nothing is more impor-
tant for a physician than to know thoroughly the neuro-
pathic disturbances of micturition ; he can render many
services to unfortunate people and avoid many guilty
mistakes. How many operations are performed on
young women under pretence that their urethra is
either too big or too narrow, when their urethra has
nothing to do with their urinary awkwardness. They
can no longer either begin the micturition, or stop it,
or control it, and you have varieties of incontinence or
retention that may become exceedingly complicated.
This rapid review of the dissociation of the functions
of alimentation confirms my general studies on hysteri-
cal paralysis and amnesias, and gives us the plan of
our next lecture on respiratory disturbances.
LECTURE XII
THE TICS OF RESPIRATION AND
ALIMENTATION
Respiratory paralyses — The problem of hysterical asphyxia
— Respiratory anesthesia — Respiratory disorders — The
rhythm 0} Cheyne-Stokes — The paralysis of the dia-
phragm with alternating see-saw respiration — Respiratory
agitations — Polypnoea — Inspiration tics — The sigh,
yawn, hiccough — Aerophagia — Expiratory tics — Hyster-
ical cough — Laughter — Hysterical bark — Complex tics
— The meteorism of the abdomen — The tics of alimenta-
tion — Bulimia — Polydipsia and polyuria — The spasms
of the jaws, cheeks, pharynx — The tic of eructation — The
tic of regurgitation — The tics of aspiration — Hysterical
vomiting — The vomiting of blood
WE have to repeat in regard to respiration a study
analogous to that which we devoted to the functions
of alimentation ; the phenomena are about of the same
kind, though they are of less gravity. On the other
hand, they are of infinite variety, and we might dwell
indefinitely on the apnceas, dyspnoeas, suffocations,
respiratory disturbances, on the varied respiratory
paralyses, on the innumerable tics, polypncea, yawn,
sigh, sob, hiccough, cough, sneeze, bark, shakes 0} the
abdomen, meteorism, without counting the tics of the
organs of alimentation, which I should like to place by
the side of the latter, namely, eructation, regurgitation,
245
246 The Major Symptoms of Hysteria
borborygms, vomitings, etc. Do not be too frightened ;
we shall be brief on all this, for, the general rules once
known, these various phenomena are always similar
to one another.
Let us first speak of the respiratory paralyses, and,
to illustrate our teaching, let us at once place a very
curious example before your eyes. The case was pub-
lished a few years ago by M. Lermoyez, a distinguished
specialist in diseases of the nose and larynx.1 Being very
interesting as regards the theory of hysteria, and being
described simply, without any preconceived idea, by
a physician who has not made a specialty of the diseases
of the nervous system, and who is not engaged in the
quarrels of our schools, this case should have attracted
the attention of scientists much more than it did.
A girl of about twenty was taken to M. Lermoyez
because her nose was obstructed by adenoid vegeta-
tions, which disturbed her respiration and attention.
The vegetations were not very big, and the operation
was effected without any difficulty. But it was noticed
that the girl did not breathe better than before, that,
in particular, she was obliged to keep her mouth open,
which dried her tongue and lips. M. Lermoyez thought
the nose was still obstructed; so he examined it mi-
nutely, but he discovered nothing, for the respiratory
channels were wide open. Wishing to prove to the
1 M. Lermoyez, " Insuffisance Nasale Hyst6rique," Societe Midicale
des Hdpitaux de Paris, January, 1899. La Presse Medicale, January
25, 1890.
\
Tics of Respiration and Alimentation 247
girl that she breathed very well through her nose, that
she kept her mouth open needlessly and out of habit,
he applied his hand on her mouth, with the idea that
she would simply breathe through her nose. To his
great surprise, it was not so. There was no breath
through the nostrils, the patient writhed as if she were
choking, and, as he insisted on her trying again, while she
was being held fast, her face and ears turned blue. In
a word, this girl suffocated when you shut her mouth,
while leaving her nose open. There was, however, no
obstacle at any point, there was only a singular disturb-
ance of the nervous system, an incapacity of effecting
the respiratory motion, of moving her chest in the least
as soon as the mouth was shut. As M. Lermoyez very
rightly said, this girl had forgotten how one manages
to breathe through one's nose. Can a finer confir-
mation be found of our teaching on functional paraly-
ses and amnesias? Have we not there a pretty dis-
sociation of the respiratory function, or at least of one
of the parts of the respiratory function? This exam-
ple at once shows you that we shall find the same
problems in the study of respiration.
Yet it is incontestable that we cannot begin with so
important and so definite a disturbance as anorexy.
The latter was, as we saw, the suppression, the dis-
sociation of the whole of alimentation, going as far
as inanition and death. It was the great functional
paralysis. Is there a corresponding absence of respira-
tion, a corresponding asphyxia suppressing all respira-
tion and going as far as death ?
The point is moot ; you may see the opinions for and
248 The Major Symptoms of Hysteria
against it in the book of M. Gilles de la Tourette.1
For my part, I hesitate to admit that it can be true. I
have seen several persons die of hunger ; I have not yet
seen any one die of suffocation. Hysterical asphyxia,
resulting from various disturbances in the respiratory
mechanism, does not seem to us to be capable, in gen-
eral, of bringing about death. A moment comes when
asphyxia brings on fainting ; that is, the arrest of the
higher functions of the brain, and the respiration, being
no longer impeded by these higher functions, is restored
owing to the automatism of the bulb.
Therein lies, in fact, the difference I indicate to you
between the alimentary and respiratory disturbances.
Alimentation, or at least the mechanical part of it, con-
sisting in the prehension of aliments, is entirely a con-
scious, voluntary function. Even if we die of hunger,
if we are in a swoon brought on by inanition, no bulbar
mechanism will cause us to eat. Whereas respiration
is not entirely a conscious and voluntary function.
Consciousness may disturb it greatly, no doubt; we
shall see how many foolish things it may do; but,
happily for us, there is outside our consciousness a
fundamental mechanism, which is the safeguard of
our hystericals. This difference between hysterical
anorexy and hysterical asphyxia as regards danger is
still another fact to be pointed out in order to justify
our mental interpretation of the disease.
However it may be, there exist hysterical disturb-
ances of respiration, which fact we understand very
well now we know the influence of the brain on
1 Gilles de la Tourette, "Traite* de la Hysteric," 1895, II, p. 124.
Tics of Respiration and Alimentation 249
this function. Flourens in 1842 connected respiration
entirely with the bulb, but since the works of Coste in
1861, of Danilewsky in 1875, of Le"pine, of Richet, of
Franck, of Pachon, and especially of Mosso, we know
very well that there is a cerebral respiration. When
the brain is benumbed, the respiration decreases and
is reduced; it seems that in total respiration there is
a part of superfluous respiration or respiration of luxury,
as Mosso called it, which depends on cerebral activity.
It is this respiration of luxury that hystericals can mod-
ify in a thousand ways.
We first find disturbances of the respiratory sensibility,
which, of course, play a fairly important part in the
evolution of the accidents, for you know that every
loss of a function or every paralysis is accompanied
by an unconsciousness, relative to the special sensations
that play a part in the function ; that is to say, with a
systematic anesthesia. You will often find more or
less diffuse anesthesias distributed over the organs of
respiration. The nose is very often insensible, and the
absence of the perception of odours — anosmia — accom-
panies the respiratory disturbances as well as the dis-
turbances of alimentation. The pharynx is very often
insensible. You know that formerly Chairon wanted
to make this insensibility, and the loss of the pharyn-
geal reflex to tickling, a symptom characteristic of
every hysteria. This is very exaggerated, though the
fact is frequent, since it accompanies the disturbances
of alimentation and those of respiration. You will
find disturbances of sensibility distributed over the
thorax and abdomen.
250 The Major Symptoms of Hysteria
What is more interesting, you will be able, in certain
cases, to recognize a very special anesthesia relative
to respiration itself. We feel our respiration, and,
above all, we feel the need of breathing. M. Bloch
in 1897 invented a curious apparatus for measuring
this respiratory sensibility. The subject is obliged
to breathe through a tube the end of which is closed
by a window of calculated dimensions. A screw
allows you gradually to reduce the dimensions of the
window, and the subject, whose eyes are shut, must
indicate at what moment he feels a difficulty in breath-
ing.
The figures obtained vary pretty much with the sub-
ject, the hour of the day, and the movements the sub-
ject has just made, but I have been able to observe that
in hystericals the figures are often very different and
infinitely smaller. The patient indicates only very late
the need to breathe, much later than a normal indi-
vidual would do, when she is already half suffocated.
This phenomenon shows a special unconsciousness of
the respiratory need, which is to a certain extent com-
parable to anorexy ; that is to say, to the unconsciousness
of hunger.
These disturbances of the sensibility are accompanied
with motor disturbances of which the subjects are more
or less conscious. They can no longer breathe volun-
tarily, though they do not arrive at total asphyxia for
the physiological reasons I have pointed out. They
can no longer add to their respiration that luxury to
which we are accustomed. The subject complains of
feeling oppressed, of feeling contracted in her neck, in
Tics of Respiration and Alimentation 251
her chest, of suffocating, of not being able to make air
enter her chest. Sometimes these phenomena are conse-
quent on accidents bearing on the respiratory organs, —
we have just seen this in the case of Lermoyez, — and the
least cold in the head may cause similar phenomena in
the patient in question. Sometimes they are consequent
on any emotion whatever, disturbing the respiration,
which the subject cannot restore. In many cases, the
respiration, abnormal during the waking state, very
quickly becomes normal again during the somnam-
bulistic state or the periods of absent-mindedness. The
accident is quite conformable to the rules that apply to
paralyses.
You should not believe, however, that these facts are
connected with real paralyses of such or such an organ
of respiration. The paralysis is less definite here than
in alimentary disturbances, again for the same reason.
A most interesting phenomenon which I have very often
recognized in this connection is a respiratory disorder,
an absence of regularity and harmony. Respiration
depends on complex organs, the nose, the pharynx, the
glottis, the thoracic cavity, the diaphragm; it cannot
be effected correctly if everything does not work at the
same time and in the same direction. It is useless to
dilate your thorax if you shut your glottis or swell your
diaphragm. This is what our patients do. The efforts
they make in their various organs are contradictory, and
that is the reason why they make only very little air
enter their chest, in spite of apparently considerable
efforts. Bear this detail in mind ; you must not think
that people breathe very much when they agitate their
252 The Major Symptoms of Hysteria
chest very much. Spirometric measures show us that
hystericals breathe very little in reality, in spite of great
apparent heavings of their thorax and abdomen. Their
respiratory disturbance is less a paralysis proper than a
want of synergy. This is also interesting for the com-
prehension of their paralyses, which are, as I have told
you, paralyses of a system. One may no longer be
able to ride a bicycle without having any apparent
paralysis of the legs.
In certain cases, however, the respiratory disturbance
may assume more determinate forms, which have greater
resemblance with known paralyses ; but these facts are
rare and still discussed. I merely indicate to you the
problem. I, myself, communicated to the Congress of
Psychology, held in Paris in 1900, a fact which is very
important in my opinion, namely the appearance of the
rhythm of Cheyne-Stokes in hysteria.1
You know, that about 1816, Cheyne of Dublin and
Stokes described a certain quite special irregularity of
respiration, which, to their mind, was characteristic of
the most serious states. As you see on this table (Figure
16), this rhythm is characterized by respiratory pauses ;
there is a series of ten to fifteen quick breaths, then an
arrest of the respiration which may last long, half a
minute in some cases ; then the active respiratory series
begins again. At the outset, this phenomenon was only
established in cerebral apoplexy, in most forms of agony,
1 F. Raymond et Pierre Janet, " Un cas du rhythme de Cheyne-
Stokes dans Physte'rie, influence de I'activite" ce're'brale sur la respira-
tion," Comptes rendus du IVme congres international de psychologic >
tenu k Paris en Aout 1900; 1901, p. 524.
253
254 The Major Symptoms of Hysteria
in certain varieties of cerebral tumours. Later on, it
was also found in typhoid fever, in uraemia, in various
intoxications. M. Mosso was the first to generalize
this respiratory rhythm singularly; he showed that it
existed in simple natural sleep when profound, and, in
general, in all states of general numbness.
At a time when I used to take systematically and with
some exaggeration the graphic of the respiration of all
the hystericals I attended, I was very much astonished
to find with one of them a graphic which exactly pre-
sented the rhythm of Cheyne-Stokes. I refer you to
my article if you wish to see studies which are not with-
out interest on the modifications of this rhythm. This
patient was always in a state of absent-mindedness and
revery. When her attention was attracted through
any process, her respiration changed and became again
nearly normal. It is the same in the other cases of
Cheyne-Stokes that I found in hystericals. This respi-
ration exists in subjects who are in a condition of half-
sleep and who are incapable of any attention. It
vanishes when the subject is more awake and more
active. These observations are interesting in that they
show the rdle of respiration in attention. They are also
important for the theory of hysteria, for they show us
here the disturbance of a function, that of attentive
respiration, which is not a function known to the sub-
ject and which consequently cannot be disturbed through
preconceived ideas.
In the same order of ideas, I wish to indicate to you,
rather as a curiosity, for this time I have seen only one
case of the phenomenon, a paralysis of the diaphragm
Tics of Respiration and Alimentation 255
with alternating see-saw respiration. You know that,
in normal respiration, the diaphragm falls when the
thorax rises, actively forces down the intestines, and
consequently swells the abdomen during each inspira-
tion. If the diaphragm is paralyzed, it cannot perform
FIG. 17. — Graphic of the respiration in a case of polypnoea, 80 respira-
tions in a minute, and of discordant respiration. The signs have the
same meaning as in the preceding figure.
this active movement; it floats like an inert veil, and
allows itself to be drawn up during each thoracic in-
spiration ; the abdomen hollows inwards instead of
swelling when the thorax dilates : that is what is called
see-saw respiration. It was formerly considered as very
dangerous and incompatible with life. Briquet already
256 The Major Symptoms of Hysteria
vaguely indicated an instance of it in a case of hysteria.
I have very accurately described an observation of this
phenomenon relating to the girl whose whole trunk was
paralyzed in consequence of a fall into a well.1 You
see in this graphic (Figures 17 and 18) that the respira-
tion is very quick, 80 respirations in a minute, and
that the graphic of the thoracic respiration, T, and of
FIG. 18. — Another graphic of the same respiration taken with increased
speed of the registering cylinder, in order to put into evidence the dis-
cordance between the thoracic (7^) and the abdominal (A) respirations.
the abdominal respiration, A, are not parallel, but dis-
cordant. The abdomen hollows inward instead of
swelling when the thorax dilates, which I have pointed
out as the sign of the paralysis of the diaphragm. The
young patient of this case had undoubtedly a number
of hysterical accidents, and this phenomenon was, I
think, of the same kind. But it is, I own, a phenomenon
1 " Ndvroses et Idees fixes," I, p. 329; II, p. 414.
Tics of Respiration and Alimentation 257
whose presence in hysterics is still open to discussion.
If this presence is confirmed, we shall be obliged to
admit more profound, older functions relative to the
movement of the diaphragm, which may be troubled in
certain serious forms of hysteria as old functions are
disturbed in hemiplegy and hemianopsia.
II
To those paralyses of the respiratory function are
added, as is always the case, and according to the rule
we know, automatic agitations. The functions are never
entirely lost in hysteria ; they are emancipated. In this
state they are performed in a more or less absurd man-
ner, without the will of the subject. As there are in the
respiratory function a quantity of small distinct func-
tions, each of them may emancipate itself separately
and give rise to very varied tics.
Let us put in the first rank the exaggeration of total
respiration, polypncea. Here is a fine case. A is a
man of thirty, a foreman in a seaport. One day he
was commanding some workmen who were working a
capstan in order to raise a tall mast. He saw a rope
break and the mast incline, and fancied that it was
falling on his workmen, which caused him to utter loud
cries. No accident occurred, but he was so fatigued
with this emotion that he was obliged to return home.
The next day it was noticed that he breathed in an odd
way; the respiratory disturbance grew little by little
and turned to a great polypncea which lasted several
months. He kept on breathing with unheard-of quick-
258 The Major Symptoms of Hysteria
ness and force ; his chest heaved very strongly and very
quickly without any interruption. He had 88 then
97 respirations a minute, instead of the normal 18
(Figure 19). This formidable respiration exhausted him,
threw him into a perspiration, and above all did not
leave him the least freedom of mind. He sat motion-
less on his chair, thinking of nothing, doing nothing but
•breathe. Notice also tnat continual paralle1 of the dis-
FIG. 19. — Graphic of the respiration in the case of polypncea of A.
turbances of respiration and those of attention. As
soon as he was hypnotized the respiration became calm,
and he was very quickly cured through this process.
But note in passing a fact to which we shall revert
later on: our patient remained cured for two years,
then he lost a little daughter, and do you know what
disturbance he was affected with in consequence of this
grief? Was it a somnambulism or a crisis, as was the
case in so many of the patients we passed in review f
Tics of Respiration and Alimentation 259
No, it was the same polypncea which began again and
had to be cured through the same process. By the side
of this case might be put that of a girl who breathed
seventy times a minute after suffering an attempt at
rape, and many of the same kind.
After those exaggerations of the total respiration, let
us rapidly enumerate the exaggerations of details, the
tics bearing on such or such a particular function. Let
us first consider inspiration tics, exaggerated inspiration,
which is connected with a certain degree of dyspnoea,
and will assume the form of continual sighs. When a
little stronger, it will be a sob, then a yawn. You know
what importance was formerly attributed to the hysteri-
cal yawn, which was thought very amusing. Nothing, in
fact, is more singular than those poor girls who, all day
long, and two or three times a minute, yawn till they
almost disjoint their jaws. It is one of the phenomena
in which the imitative contagion is best exhibited ; it is
also a phenomenon in relation with the disturbances of
alimentation.
It is the same with the last inspiratory tic, the hiccough,
which is also very frequent. The hiccough is nothing
but a very rapid inspiration with a certain degree of
spasm of the glottis. The air cannot reenter quickly
enough, because the inspiration is too rapid and also
because the glottis is a little closed ; this results first in
a certain characteristic noise, and also in a certain
thoracic vacuum, which causes an aspiration in all the
organs. You can see this fact in the graphic of hiccough
(Figure 20) : when the hiccough appears at the beginning
of each inspiration, the abdomen is aspirated and the
260 The Major Symptoms of Hysteria
graphics of both respirations, thoracic T and abdominal
A, are momentarily discordant.1
This will presently play a great part in the phe-
nomenon of aerophagia, with patients who swallow air,
and in vomition. Let us only remark that the hiccough
is one of the most frequent phenomena. When looking
FIG. 20. — Graphic ot respiration in a case of continuous hicough, A hic-
cough in each respiration at the beginning of the inspiration.
over my notes to prepare this course of lectures, I
counted twenty-nine great observations of hysterical
hiccough that had lasted for months together.
Among the expiratory tics, we shall first range the
hysterical cough, that little phenomenon so frequent at
the outset of the disease. There are, in this connection,
clinical observations on the evolution, which are facts
of experience and cannot very well be accounted for.
1 " Nevroses et Idees fixes," II, Observation 100, p. 360.
Tics of Respiration and Alimentation 261
Thus the hysterical hiccough is, to my mind, a rather seri-
ous phenomenon of bad prognosis. It points to a great
hysteria; the hysterical cough, which is almost like it,
is a more commonplace and less serious phenomenon.
Almost every girl has had an irrepressible cough in con-
sequence of a certain cough, of efforts in singing, or of
fits of bashfulness. When the phenomenon is isolated,
it is very difficult, in my opinion, to say whether we
have to deal with incipient hysteria or with a mere
psychasthenic tic. As always, pay attention to the
state of the sensibility, to the degree of the unconscious-
ness, and to the effects of distraction.
One degree further: you have hysterical laughter,
those interminable crises of laughter which develop
for hours together like real fits of hysterics. You know
the psychological problem of laughter, and are aware
that this phenomenon, apparently so amusing, is a tor-
turing problem for the unfortunate scientists. You
should not fancy that laughter is always the expression
of joy. Certain hysterical laughters are of this kind.
Thus a girl of bad morals had undergone a little surgical
operation for which she had been half chloroformed,
but, during this trifling operation, young students of
the hospital, who surrounded her, had kept joking her
and making her laugh. Probably under the influence
of the chloroform, this laughter was transformed into
an independent automatic phenomenon, and persisted
as a tic.1 But, in other cases, laughter accompanies
pain; it accompanies nervous exhaustion and is to be
observed in great delirious attacks. It is probably a
1 " NeVroses et Ide"es fixes," II, Observation 98, p. 352.
262 The Major Symptoms of Hysteria
phenomenon of derivation of the nervous strength very
difficult to account for.
One degree further, and the expiration, more violent
and accompanied with spasms of the glottis, will bring
about the most varied cries, the famous hysterical barks.
You know that they occurred epidemically in the Middle
Ages, and that, in the convents, nuns began by hundreds
to howl, bark, or mew. It was necessary to threaten
them with a hot iron to silence them. It is by far less
widespread nowadays and is not so epidemic, but never-
theless it exists very often under various forms. In
many cases, this tic is mixed with some phenomena of
disturbances of speech of which we have already spoken.
Little by little, the bark becomes a particular word, the
name of a person, or some obscenity or other.
You understand, in fact, that all these various tics
we have analyzed may be mixed with one another and
give rise to complex phenomena. One of the most
interesting is that to which I alluded just now when
speaking of the hiccough. The hiccough, through the
vacuum it determines in the thorax, produces a draught
in the oesophagus and causes the subjects to swallow air.
After three or four hiccoughs, the stomach is full of air,
which brings about another fact ; namely, the expulsion
of those gases from the stomach through an eructation.
Therefore, as you may easily notice, great hiccoughs are
always interrupted now and then by eructations of
different tones. I used to note down in the following
manner the noises that one of my patients regularly
made : "nioup, nioup, nioup, zaa," and thus indefinitely.
This same patient complicated her respiratory dis-
Tics of Respiration and Alimentation 263
turbances a little by adding to them disturbances of
speech. Thus, the noises of her hiccough were often
transformed into veritable words ; now and then, she
would repeat: "all right," and "all rock," which
sounded about like the name of her medical attendant.
It even appears that the noise " nioup, nioup " had been
consequent on the reading of a novel in which some
savages sang : " iou, iou."
With those same complex tics of respiration I should
like to connect an exceedingly curious phenomenon;
the swelling of the abdomen or meteorism. It is neces-
sary that you should know this phenomenon well, be-
cause it is the one which gives rise to the most common
and grotesque medical errors. You know of those
newly married young women who long to have a child ;
the menses are suppressed, the abdomen becomes big
and hard, the breasts hard and coloured; there are
nauseas and vomitings. A midwife is called in. She
feels the arm of the child and fixes the date of the
delivery. This date comes and nothing ceases; the
expectation continues. One fine day, everything dis-
appears, without its being possible to know what has
become of the child. It is the famous nervous preg-
nancy, of which I have noted down about ten cases, and
of which one should beware. The error is less serious
here than when these swellings of the body are attributed
to various tumours, and operations are counselled.
However that may be, this abdominal swelling is not
very easy to account for ; the old theories of the time of
Charcot connected it with a paralysis of the intestinal
walls, admitting of the dilatation of the gases. I am
264 The Major Symptoms of Hysteria
much more inclined at the present day to believe that
it is due to respiratory phenomena. One of those
phenomena is a spasm of the diaphragm, which re-
mains lowered and compresses the viscera forward ; but
it only brings about the smaller swellings. The other
is in relation with that same aerophagia which I have
just mentioned. Certain patients eject the air they
have inhaled by means of eructations. Others do not
succeed in emptying their stomach through the upper
end; they force their pylorus open and send this air
into their intestine, which determines varied disturbances
of the digestion, and, in particular, diarrhoea, but, at
the same time, a sometimes enormous swelling of the
whole abdomen. You may imagine many other com-
binations of these respiratory disturbances.
Ill
But, before leaving the subject of visceral disturb-
ances, I should like to tell you briefly of some other very
important tics which depend on the function of alimen-
tation, of which we have spoken. Most of these tics of
alimentation besides are at the same time complicated
with a respiratory phenomenon.
In the first place, the function of alimentation,
emancipated from the personal consciousness, may be-
come exaggerated and give rise to various forms of
bidimia. Patients affected with bulimia cannot stop
eating; they constantly ask for food. The fact of
bulimia, it is true, exists in hysteria, but be on your
guard ; it mostly belongs to psychasthenic impulsions.
Tics of Respiration and Alimentation 265
It is to be met with among those patients who feel
weakened, depressed, and have taken the mania to
revive themselves by some stimulant or other, adopted
more or less at haphazard.1
Some have the mania of always eating; others —
and they are the most numerous — have the mania of
drinking alcohol. Yet there is one form of those manias
which is in relation with a hysterical phenomenon, and
which it is right that you should know. It is polydipsia,
which is not to be confounded with dipsomania. The
dipsomaniac seeks after exciting drinks and it is alcohol
he wants to swallow. The polydipsical is not so hard
to please ; he is content with pure water, but he swallows
twenty liters of it a day. This excess of drink has an
inevitable consequence; namely, an excess of urine,
polyuria. Some of these patients discharge eighteen liters
a day. Curiously enough, more stress has generally
been laid on this consequence of the phenomenon than
on the phenomenon itself. Polyuria was studied among
the disturbances of the renal secretion to be met with
in neuropathic patients. I think it should rather be
connected with deliriums or with the disturbances of the
functions of alimentation, which bring about the im-
pulsion to drink indefinitely.
But after those great automatisms of the function of
alimentation, we have to point out a host of partial dis-
turbances, spasms of the jaws and cheeks, spasms oj
the pharynx, tics of perpetual spitting and salivation.
1 Pierre Janet, " On the Pathogenesis of Some Impulsions,"
The Journal of Abnormal Psychology, edited by Morton Prince,
April, 1906, p. 3.
266 The Major Symptoms of Hysteria
Ptyalism, which is frequent in certain melancholy
deliriums, exists also in hysteria. I do not insist on the
spasms of the oesophagus, to which we alluded in our
last lecture. You also know the tics of eructation and
the belches, of which; I have just spoken to you in con-
nection with the hiccbugh. But I must point out to you
a complication of the phenomenon, which is called
regurgitation, merycism. Some of these patients learn
to ruminate like cows. They know how to bring back
into their mouths the food they have swallowed. It has
been said that this constituted an odd physiological
phenomenon, in which the movement of the oesophagus
was reversed. I think, rather, that it is one of those
curious phenomena of aspiration, induced by abnormal
respirations. By making a movement of aspiration
very quickly while shutting the glottis and preventing
the air from entering into the lungs, one induces a
vacuum in the thorax, which can react on all sides. A
certain individual, who was formerly celebrated in Paris,
thus drew up air through his anus and knew how to
eject it in a melodious way. We know that many thus
draw air into their oesophagus. But the aspiration into
the oesophagus may be effected in the opposite direction
and throw up the contents of the stomach. We shall
see this mechanism assume a greater importance still
in, the following phenomenon, the only one that is really
important ; namely, hysterical vomiting.
Hysterical vomiting is almost as serious as anorexy
itself. It is certainly responsible for several deaths. It
almost always complicates all the preceding disturb-
ances. This vomiting is rarely pure ; that is to say, it
Tics of Respiration and Alimentation 267
rarely depends on hysteria alone. Nowadays, as I
told you at the outset, the attention of physicians is
much more directed to associated hysteria, to the
organic affections that are at the starting-point of
hysteria, or its localizations. Lately, MM. Mathieu
and Roux, in a paper in the Gazette des Hdpitaux,1 again
insisted on this point in connection with hysterical vomit-
ings. Almost always, they said, there is at the starting-
point some organic affection which induces the beginning
of the phenomenon. This primum mobile may be either
the vomitings in pregnancy, or alcoholic gastrites, or
gastrites of any kind, or, above all, ulcers of the stomach,
of which we shall have to speak again.
But, however it may be, what characterizes the phe-
nomenon is the exaggeration and regular and indefinite
reproduction of the vomiting long after the action of
its cause. This vomiting, in fact, is exceedingly rapid
and easy; it immediately follows the meal; it is ac-
companied with very little nausea and no effort. It is
repeated with any kind of food and produces the most
dangerous inanition. It is also in cases of this kind,
that the tuberculous complications supervene which
almost always terminate hysterical inanitions. A
rather characteristic phenomenon is that the patients
cannot seem to endure the arrest of the vomiting.
When, through any process, they are prevented from
vomiting, they exhibit anguish, are agitated, writhe in
every way, complain of a thousand sufferings, and
finally become unconscious in a great hysterical attack.
1A Mathieu and J. Ch. Roux, "L'Hyste'rie Gastrique," Gazette
des Hdpitaux, February 22, 1906.
268 The Major Symptoms of Hysteria
Many patients have thus to choose between delirious
attacks and perpetual vomiting. This is quite the
character of an automatic agitation which they can no
longer control.
Formerly an apparently very serious accident was
always brought close to hysterical vomiting, namely, the
vomiting of blood, and these hematemeses were un-
hesitatingly connected with hysteria. It had been
noticed, and that very rightly too, that these hema-
temeses almost always coincided witfc the beginning of
the menses, and it was usually said that these women
have their menses through their stomachs. At the pres-
ent time, this notion of these neuropathic gastric hemor-
rhages tends to become obliterated, and physicians are
inclined to say that they are due to an unrecognized
ulcer of the stomach. The symptoms that were formerly
indicated as conducing to the diagnosis seem to have
lost something of their value. The pain occurring long
after the meal, the irregular paroxystic crises, the rela-
tion with the menses, even the relation with moral
emotions, all that was found again in the ulcer. Kuttner
in 1895 pointed out a patient whose first vomiting of
blood came on after the death of a relative. He was
led to cut open her stomach and found a real ulcer.
Another woman, after a scene in which her daughter
left home forever, had a vomiting of blood which formerly
would have been unhesitatingly connected with emotional
neuropathic disturbances. Her stomach was also cut
open, and an ulcer was found. It is in the work of
MM. Mathieu and Roux that you will find a very well-
conducted discussion of this fact. The authors, how-
Tics of Respiration and Alimentation 269
ever, hesitate to make a complete denial of purely
hysterical hematemeses. They admit it in hemor-
rhagic pituites, in pituitous vomitings tinted with blood,
in hematemeses coinciding with multiple hemorrhages
of the skin, of the ear. Then why should it not be
admitted that, in certain cases, this disposition to hemor-
rhage may be localized in the stomach?
Be very prudent, however, in this diagnosis, which,
at the present time, must be less readily accepted than
formerly. The same prudence, even still greater pru-
dence, is, of course, necessary when you have to deal
with fecaloid or still stranger vomitings which some of
those subjects may exhibit. They are almost always
due to simulations or deliriums, which you must know
how to recognize. The real tics of alimentation and
respiration we have just described are numerous enough
for us not to complicate their list with doubtful phe-
nomena. One of the characteristics of the present study
of hysteria is that efforts are made to limit the disease
more clearly than formerly and to leave out mysterious
phenomena or phenomena depending on another malady.
Our enumeration of the symptoms of hysteria is already
complete enough, and we can now enter upon more
general studies on the common characteristics of these
diseases.
LECTURE XIII
HYSTERICAL STIGMATA — SUGGESTIBILITY
The need of unity in presence oj the diversity 0} hysterical
phenomena — The problem of the stigmata — The stigma of
anesthesia — The historical importance of this stigma — Its
exaggeration — The two meanings of the word " stigma " —
The psychological stigmata — The character of hystericals
— Instinctive falsehood — The mental stigma of suggesti-
bility— The distinct meaning of the word " suggestion " —
Description of the principal facts of suggestion — The
complete development of the elements contained in an idea,
without any participation of the will or of the personal con-
sciousness— The distinction between real suggestion and
normal phenomena — The conditions of suggestion — The
systematization of images — The absence of suggestion
properly so-called with normal people — The weakening
of consciousness, the lack of synthesis — Suggestibility as
a sign of hysteria — The disappearance of suggestibility
after recovery from hysteria
THE examination, even rapid, of the numerous acci-
dents of hysteria raises inevitable problems in our minds.
The most important one, the one that always torments
the human mind in all possible studies, is the problem
of unity, of the conception of the whole, of the essential
and fundamental character. The first authors who
described hystericals were always struck with the
diversity and complexity of their symptoms. "It is
270
Hysterical Stigmata — Suggestibility 271
not a disease," said one of them, "it is a host of ail-
ments." And you know that, to express the change-
ableness of hysteria, Sydenham called it "that Proteus
that cannot be laid hold of." Sometimes it takes the
form of deliriums such as we have seen in somnam-
bulisms, and we are in the domain of mental diseases.
Sometimes it presents accidents of the arms and legs,
which make us think of articular and muscular lesions.
Now we meet with disturbances of the stomach or lungs,
and we have to deal with visceral diseases, gastrites, and
pneumonias. You may understand the perplexity of
the first clinicians, the best of whom came to abhor
and loathe such a malady. They did not seek to take
away from it its bad renown, for their scientific dis-
satisfaction discomposed them, made them impatient
with the subject, and inclined them to call him a simu-
lator and a debauchee. Slow was the reaction against
this tendency, brought about by a very natural per-
plexity. The best answer has been to make hysteria
intelligible, and, above all, to seek to give it some unity,
by linking together those scattered accidents, by find-
ing in all of them some fundamental features, which
serve at once to explain them, to connect them with
one another, to diagnosticate and to identify them.
This need of unity under diversity, which has never
been so serious as in the study of hysteria, has enlarged
with regard to this study a problem that, upon the
whole, exists in every medical research : the problem of
the stigmata. If one admits that somnambulism,
paralysis, vomiting are, all three of them, hysterical
phenomena, in spite of their enormous differences, there
272 The Major Symptoms of Hysteria
must be something common among them. In the
three patients a common character must be found,
which is with all of them the starting-point of the ob-
served symptom and serves to diagnosticate the hysterical
character of this accident. That common character is
the stigma, and one may say that, since the beginning
of the scientific study of hysteria, all the attention of
clinicians of any merit has been directed to the study
and search of the stigma.
Of course this stigma has varied very much, for it
reflects the theories of each period on the diseases one
considers. Now this essential stigma of hysteria was
the convulsive attack, now the hysterical bawl. You
will read with astonishment the books of the beginning
of the nineteenth century, in which you will find that
hysteria is recognized from the bawl of nervous women.
For about fifty years past, other more important char-
acters have, become predominant, and you are aware
that, especially under the influence of the school of
Charcot, one symptom has become the preeminent
stigma; namely, anesthesia.
The singling out of this symptom was, in some degree,
an unconscious return to the past. In the Middle Ages,
people had also a kind of diagnosis to make, in order to
recognize witches and those possessed as well as possi-
ble before burning them, and you know the singular
method they made use of. A surgeon or an expert
woman examined the body of the sufferer on all sides,
Hysterical Stigmata — Suggestibility 273
testing the sensibility with a sharp needle in order to
discover the devil's claw, that insensitive patch which
was a certain sign of witchcraft. They examined every
nook and corner, for the devil is in the habit of con-
cealing himself in the most hidden places, and they
actually tested the sensibility of the mucous membranes
as well as that of the skin. The fact is really very
curious and shows an instinctive medical perspicacity
that has not been sufficiently celebrated. Well, Charcot
nearly brought us back to the time of the celebrated
inquisitor Bodin, and, in our clinics, we are somewhat
like the woman who sought for witches. We blindfold
the subject, we turn his head away, rub his skin with
our nail, prick it suddenly with a hidden pin, watch
his answers or starts of pain; the picture has not
changed.
This research has allowed clinicians to establish that,
in many cases, various anesthesias accompany most
hysterical symptoms. In the case of paralyses or con-
tractures of the limbs, the phenomenon is very clear
and regular, whether in regard to cutaneous sensitive-
ness, or, better still, — for it is very important, — to
muscular sensitiveness. In the case of sensorial acci-
dents, the anesthesia is very often quite distinct at the
periphery; sometimes it conceals itself by taking
extremely interesting forms, which the inquisitors did
not know how to seek for, such as the contraction of the
visual field. In the case of visceral accidents and of
certain motor disturbances which are rather agitations
than paralyses, the question becomes more delicate.
Often the superficial anesthesia of the region indicates
274 The Major Symptoms of Hysteria
the diseased organ, but, to be sincere, this is not always
true. When we have to deal with the great mental
accidents, with all the innumerable forms of somnam-
bulism, the anesthesia sought for by Charcot is often
to be met with, but it does not constitute the absolute
rule.
That method which consisted in characterizing
hysteria by anesthesia and by the contraction of the
visual field has enabled medicine to make great progress.
It has successively brought about the discovery of a
crowd of unknown hysterical symptoms, of special
spasms, tremors, localized pains, etc. Must it con-
tinue to dominate in medicine and must anesthesia be
made an essential symptom? The discussion on this
point began at the very outset of the teaching of Charcot ;
his adversaries — and they were numerous — always
opposed his interpretation of this symptom. The great
and interminable quarrel about traumatic neuroses,
which began especially in Germany in connection with
railway accidents, rests on this question. This criticism
is in great part justified, for hysterical Anesthesia cer-
tainly does not play in practice the absolutely pre-
ponderant r61e that Charcot maintained it did.
First of all, it is only too certain that this anesthesia
is not so easy to recognize as was believed. It has, as
we have seen, very delicate psychological characteristics,
which make the answers of the subject very often diffi-
cult to interpret. But, above all, it is very mobile, very
impressionable. Now, your examination alone will
suffice to cause a real anesthesia to disappear ; now —
and this is more serious — your manner of interrogating
Hysterical Stigmata — Suggestibility 275
will create outright an anesthesia that did not exist.
The study of the stigmata is made on no patients so
well as on old ones, real pillars of the hospital, who
have already been examined thousands of times. When
you have to deal with new patients, who have not yet
been touched, you recognize with astonishment that
anesthesia is rarer, less important than Charcot said.
On this point I apologize myself, and acknowledge
that, under the influence of la Salpetriere, I formerly
attributed more importance to anesthesia than I would
do now.
What then must be our conclusion as to the r61e of
anesthesia as a stigma? We should understand one
another and not ask the sciences of observation, which
are so difficult, to furnish us with absolute theorems.
In my opinion, the two meanings of the word "stigma"
should be separated. In the first place, it has a theo-
retical meaning, it indicates the fundamental character,
the causal character from which the rest of the disease
springs. For instance, if you consider a tuberculous
lesion, the real stigma will be the bacillus of Koch, be-
cause we consider it, at least at the present day, as the
cause of all the innumerable lesions, however varied
they are. It will be the same with the existence of
the pale spirochsete of Schaudin in syphilis, if the hypoth-
esis is corroborated. Now, we must own that anes-
thesia does not play this r61e in hysteria, that we do
not know the microbe of that malady, that there is
probably none, and that we know no better its his-
tological lesion. From this standpoint, Charcot's stigma
has failed.
276 The Major Symptoms of Hysteria
But the stigma has another meaning, which is prac-
tical. It is a mere means of diagnosis. Now, anesthesia
accompanies two-thirds of the hysterical accidents. It
has, besides, the -character of persisting long after the
disappearance of the accident. The result is that
almost all the hystericals who, at present, show a serious
phenomenon, have had in the past one of those acci-
dents that leave behind them, as a trace, some persisting
anesthesia. I examine in a subject a perplexing mental
or sensorial disturbance, and find traces of a hemi-
anesthesia. It means that, in the course of his life, he
has already had, in a greater or smaller degree, a hysterical
hemiplegy. I establish with him a contraction of the
visual field which he did not even know; it proves to
me that he has had in a greater or smaller degree a
hysterical amaurosis. Is not this recognition extremely
important for the interpretation of the present accident,
even if I do not believe at all that this anesthesia ac-
counts for his accident? Very often, in medicine, the
stigmata are not so serious as the bacillus of Koch.
You examine a patient who has serious intestinal dis-
turbances and fever; you seek on his breast for the
little rosy lenticular spots, and, if you find them, you
say : " It is typhoid fever." Yet you do not know the
r61e of those spots in the evolution of typhoid fever.
I think, therefore, that the anesthesia of Charcot must
remain in practice a very important stigma, the search
for which is in the first rank of the methods of diagnosis,
but that it is not the only or fundamental symptom of
hysteria. There are some troubles and symptoms
which we connect with hysteria, though we do not
Hysterical Stigmata — Suggestibility 277
recognize any anesthesia. We must look more deeply
for other phenomena playing the r61e of stigmata.
n
Anesthesia pleased the physicians, because this symp-
tom is in some manner intermediate between physical
and moral phenomena. They could not make up their
minds to make hysteria a purely mental malady. They
always declared that such was the case, but, in reality,
they quickly forgot that declaration to consider by pref-
erence physical symptoms and measure them through
physical methods. Since hysteria has become a more
distinctly mental malady, it is in the mind that we
must seek for the stigmata and that we have a chance
to find more general stigmata co-existing with all the
accidents.
Scientists had long felt that there was a hysterical
mental state ; you know that it was the fashion to write
theses on the character of hystericals. There were
first brought into relief in the works of Legrand du
Saulle, Ballet, Mcebius, Tardieu, Richet, etc., certain
curious and striking, but of course somewhat excep-
tional, features. Our poor patients were not lucky.
Formerly, they were burnt as witches ; then, they were
accused of all possible debaucheries; then, when the
manners had become gentler, one was content with
saying that they were versatile to excess, remarkable
for their spirit of duplicity, of falsehood, of perpetual
simulation. "A common feature characterizes them,"
says Tardieu; "namely, instinctive simulation, the in-
278 The Major Symptoms of Hysteria
veterate and incessant need of unceasingly lying, with-
out reason, solely for the sake of lying, and this not
only in words, but also in action, by a kind of parade
in which the imagination plays the principal part, gives
birth to the most inconceivable incidents and sometimes
proceeds to the most disastrous extremities." So false-
hood becomes the stigma of hysteria.
Do not smile; there are still many physicians who
take that seriously. No doubt falsehood exists in
hysteria ; and often it is even very amusing. I regretted
very much, when we studied mental disturbances, not
having the time to devote a lecture to the accidents of
falsehood. I have known two or three subjects, one
especially, who were really magnificent. This poor
woman has had all her life — that is, for thirty years —
an extravagant need of falsehood, above all, of false-
hood by letters. Her greatest happiness consists in
devising amorous correspondence ; she sends to an in-
dividual, man or woman, marvellous letters in which
she states that he or she has inspired her with a sudden
love when passing on the promenade. What is most
wonderful is that it always takes. The gentleman
answers paste restante, and she goes on with the cor-
respondence for months or years. What is sad is that
it ended before the assizes ; but the observation deserves
to be published.
Falsehood is, in my opinion, one of the mental acci-
dents of the neurosis, one of the deliriums that the
hysterical may have in a very serious or in an attenuated
degree, just as she may have somnambulisms or fugues ;
that is to say, ambulatory fits. But it is very well known
Hysterical Stigmata — Suggestibility 279
that all hystericals have not necessarily made fugues.
Likewise they have not necessarily all of them the mental
accident of falsehood. Its frequency has been much
exaggerated. It has been so often described that, in
the end, patients were trained to present it. Formerly,
Legrand du Saulle was convinced that all hystericals
had red flowers in their hair and red ribbons tied to
their bedsteads; at length he made them believe it.
We cannot dwell on these first mental stigmata, which
only show the importance that must be attached to
psychological disturbances.
In reality, the great mental stigma that modern studies
have brought into evidence is the mental phenomenon
of suggestion. No doubt I begin to think that the im-
portance given to it, in particular in the last works of
Babinski, is somewhat exaggerated, but it is certain
that this exaggeration is as yet very slight, and that
suggestion is indeed one of the most fundamental stig-
mata of the hysterical state. But it is necessary to
define this phenomenon exactly, to give a distinct
meaning to the word, because physicians are in the
habit of using it in an extremely vague manner, of
comprising under this word all possible mental phe-
nomena.
It is needless to recall the fundamental phenomena
of suggestion; you know them very well. You cause
any idea whatever to penetrate into the mind of the
subject through any means you please, through sensa-
tions, signs, and especially speech. Note this fact:
there must be an idea. The subject must have the
thought, the conception of something precise. This
280 The Major Symptoms of Hysteria
idea does not seem to conduct itself in him as it usually
does in normal minds.
When somebody puts an idea into our head, this
idea brings in its train, it is true, other thoughts which
revolve around it, some more or less vague images,
some gestures, or some incipient movement. If you
speak to me of the falls of the Niagara, I cannot help
seeing dimly, in a kind of penumbra, a few fragments
of that fine scenery. If I am surrounded with calm, I
shall be able to dwell a little on that remembrance and
to call to mind a few particulars of my journey. The
images I see are always dim, and the words I speak, I
speak to myself. I always know very well that I am
not actually before the falls, and in reality, I do not see
them. If you speak to me of dancing, of balls, of
rhythmical music, the idea awakens in me, even to this
day, an inclination to move my legs, feelings of rhythms.
I may even go so far as to move my feet in cadence.
But don't be afraid, nobody in a drawing-room will
be aware of it, for the movement is very slight and is
perceptible only to myself. It is thus that things happen
when ideas are called up in our minds.
It is quite different with really suggestible individuals.
The idea seems to be transformed and to become at
once another psychological phenomenon, an act or a
perception. In fact, they almost immediately move
their limbs in a manner quite visible outwardly. They
really get up and dance ; they walk, run, jump, struggle,
cry. Instead of confining themselves to thinking the
object, they seem to see it in reality or to hear it. They
conduct themselves before our eyes like individuals who
Hysterical Stigmata — Suggestibility 281
have perceptions and not ideas ; they reply to imaginary
words; their facial expression is that of a person who
hears. If we question them, they tell us without hesi-
tation that they see Niagara before them, and the
spectacle has so much intensity that it seems completely
to efface the normal vision of the things that surround
them.
Other ideas become connected with the first, still
with the same intensity and the same transformation
into actions and perceptions. They seem to make a
complete journey ; they go along the edge of the falls,
over the bridge, down the ravines; they receive the
water in their face, etc. All these ideas grouped to-
gether form a very close association in their mind, and
it will henceforth suffice to call up one to give birth to
all the others. It is no longer necessary to say the
word " Niagara." A mere vague noise brings about the
whole dream. These associations are very important
in suggestions, for they determine particular reactions
of the subjects to such or such excitation. Thus such a
subject may have acquired the habit of convulsions or
contractures of the limbs when he sees an electric ap-
paratus or is touched with a magnet. These patients
have shakes in their muscles as soon as you put the
electrodes of the apparatus on their arms, even if the
current does not pass through. Others will experience
burns or refrigerations or will feel relieved when they
see gold, silver, or iron plates applied to their limbs. It
is that which has caused so many gross medical mis-
takes. Alas, what is left of the big books on the action
of metallic plates, of resin plates, on the action of a
282 The Major Symptoms of Hysteria
breath, indicated by M. Dumontpallier, on the action of
passes of the bands turned pointwise towards the sub-
ject ?
Another important characteristic of suggestion will
manifest itself in the visceral domain. No doubt cer-
tain ideas awaken also in us certain visceral sensations,
a slight nausea, or vesical sensations, but all that is
very slight, just like the feeling of dancing. An essential
trait of those patients, it was said, is that they make their
thoughts penetrate into their viscera. The idea of
vomiting brings about real vomiting, an imaginary
purge with pure water brings about a real diarrhoea ;
the menses are stopped or restored with pills of mica
panis. This is again a very essential phenomenon, for
it seems to come close to the real accidents which are to
be observed with patients in many circumstances.
We may generalize the essential phenomena that take
place in these different cases. The idea is always, as
we have already remarked with regard to somnam-
bulisms, a system of images, each of which has dif-
ferent muscular or visceral properties (see the figure i
in the first lecture). With the normal man, these systems,
which are always very numerous, stop one another and
do not develop. In suggestion, each idea seems to
develop to the maximum, to give all it contains in the
way of images, muscular movements, and visceral phe-
nomena. This complete development of all the elements
contained in an idea is an essential characteristic of the
phenomenon.
But, you may say, this development can also be some-
times effected with us. A painter, a novelist, develops
Hysterical Stigmata — Suggestibility 283
his ideas, seeks for all their elements, renders them as
living as possible. It is what all of us do when we try
to perform some work, for then the idea brings about
material movements of our limbs. The thought of
looking for a book causes me really to look for it. This
is quite true, but, in all these cases, the development
only takes place through a particular mechanism. An
accessory force is added to the idea by the will ; namely,
attention, personality. These words represent an en-
semble of very powerful tendencies, which are formed
in us by all our past, and these tendencies are added
to the idea, too weak by itself, to make it grow. You
know the trouble, the voluntary and conscious effort
that the development of his idea costs an artist.
In suggestion you meet with nothing of the kind.
There is no effort on the part of the subject, no addition
of strength from his anterior tendencies, no work of
his personality. On the contrary, he does not seem to
realize the development of what takes place within him.
As has often been recognized, he forgets his sugges-
tions as soon as they are ended. He seems to be very
little conscious of them while they are being executed.
Very often he executes them without knowing it, quite
subconsciously. In this connection, it is very important
to remark that not all the phenomena executed by sub-
jects of this kind are suggestions. They may, like
normal individuals, act out of compliance with our desire,
add to the idea the force given them by the wish to obey,
to ingratiate themselves with us, by a regard to their
interest or the fear of punishment. One should not say
that a hospital patient, whom one frightens and be-
284 The Major Symptoms of Hysteria
wilders, and who hastens to execute any foolish act in
order not- to displease the physician, is an individual
beset with a suggestion. In order that there may be
suggestion, it is precisely necessary that all these normal
causes of development should be wanting, and that the
idea should seem to develop to the extreme, without any
participation 0} the will or of the personal consciousness
of the subject.
Bear this definition in mind; many authors, who
launched too precipitately into these psychological
studies, considered themselves satisfied when they had
merely remarked the moral character of the phe-
nomenon. They said that suggestion is an idea that
penetrates into the mind of the subject, and stops
there. This is childish. As I have so often tried to
show, any idea entering into the mind is not a sugges-
tion. We recognize the fact ourselves. If we show
astonishment at the phenomenon of suggestion, it is be-
cause we think it offers something abnormal and excep-
tional. The subjects themselves notice it. Their minds
are not filled all day long with suggestions. They know
very well how to distinguish what is suggestion in them
from what is not. A patient has sometimes answered
me in a vulgar but quite characteristic way : "Sir, I do
not know the reason, but the thing did not take."
"What do you mean? You did not understand
what I said?"
"Yes, I understood quite well."
"Then you do not wish to do that, you do not accept ?"
"I accept all you please. I am quite ready to obey
you, and I will do it if you choose; only I tell you
Hysterical Stigmata — Suggestibility 285
beforehand that the thing did not take." With the
preceding definition of suggestion, these answers of the
patient would have no meaning. The idea, having
penetrated into the mind and having been accepted,
should be accounted a suggestion. Yet the patient was
right ; she has experienced suggestions, she knows what
they are, and, although she accepted the new idea
willingly, and with absolute confidence and obedience,
yet she felt that things were not proceeding in the same
way, and that it was- not a suggestion. One should
not fall into this exaggeration and take away from the
word "suggestion" all precision of meaning. As the
ordinary psychological terms, memory, association of
ideas, belief, resolution, designate distinct facts, so the
word "suggestion" must also designate a very special
fact, the complete development of an idea which takes
place without the will and the personal perception of
the subject.
Ill
Now that you have formed a precise idea of suggestion
and are not likely to confound it with any other psy-
chological phenomenon, you will readily accept an in-
evitable consequence of this first remark; namely,
that suggestion is no longer a commonplace and constant
phenomenon. It presents itself only in certain cases
and under certain conditions which it is necessary to
determine. Suggestion appears to us to present two
great characteristics: First, it is a complete develop-
ment ; second, it is a development independent of certain
ideas. Both characteristics require certain conditions.
286 The Major Symptoms of Hysteria
It is necessary, in the first place, in order that an idea
shall develop itself, that the innumerable images of which
it is composed be awakened and arrange themselves in
a series in a proper manner. This is not an unimportant
condition, though it is not always met. Certain minds
no longer retain images of their sensations and, above
all, they no longer keep up the systematization of these
images. They are incapable of calling them up and
arranging them in a series. They are therefore not
suggestible subjects. The type of such individuals will,
from the first, come under the name dementia. It is
quite plain that with an insane person the images are
no longer systematized, and that, consequently, the ideas
are no longer either understood or developed. Much
hope has been cherished for the therapeutics of insanity
through suggestion ; we are afraid this operation can be
applied only to very special cases. Suggestion requires,
in order to be developed, a mind relatively sane. The
first condition of suggestion is a certain strength of mind,
and some patients are not suggestible because they are,
so to say, below suggestion, like some infected patients
who are incapable of having fever.
But ought we immediately to pass to the other extreme
of opinion and maintain that suggestion is compatible
with a mind normally healthy, and that it is continually
met in the sanest persons? This is an opinion which
appears to us equally unsound.
Despite the affirmations of certain authors, we must
confess that we have not succeeded in giving suggestions
to people of normal good health. It is useless to discuss
the sense of the word "health," and to pretend that ideal
Hysterical Stigmata — Suggestibility 287
health does not exist. It were repeating the sophism
of the Greeks regarding the bald-headed man. We
speak of men generally considered normal, without
pathological or hereditary antecedents or personal
blemishes in a neuropathic sense, without actual defects
medically appreciable. If we take a person of that kind
(a kind that is numerous, we must confess), and if we
state to him that there is a little dog at the corner of the
table where he is sitting, he will laugh in our face and
experience no hallucination whatsoever.
This fact appears to us incontestable, and to speak
of suggestion with sane persons, one is obliged to consider
quite different facts, effects of education, habits, rec-
ollections, beliefs, etc. They are psychological phe-
nomena which are apparently akin to suggestion, but
the mechanism of which is very different. These facts
have only gradually become automatic, thanks to the
patient's consent. These acts, even to-day, are ac-
cepted by the individual who is aware of them and as-
similates them with his personality. The result is that
such actions are not aggressive ; they are limited in their
development by other thoughts with which they are
brought into relation. Docile, obedient persons, dis-
posed to think of others as having more intelligence and
experience than themselves, and, on account of this,
apt to believe what they are taught, are not suggestible
persons. This complete automatic development of
the personality, in the fashion of a parasite, is not met
with in the normal mind.
On the other hand, every time that we have estab-
lished in a person unmistakable suggestibility, we have
288 The Major Symptoms of Hysteria
had no difficulty in demonstrating numerous and evi-
dent traces of mental disease more or less grave, such
as excessive absence of mind, or even properly called
anesthesias, attacks, paralyses, fixed ideas. We find
in the past of such persons all sorts of neuropathic
accidents, and the simple fact that suggestibility is still
persistent nowadays should impose great reserve on the
physician in regard to prognosticating their future.
Suggestibility with them should in fact not be considered
a simple exaggeration of docility and normal belief.
Such persons are oftener neither docile nor believing.
They have an unsteady, undisciplined disposition;
they themselves recognize that they do not succeed in
believing. "I have no more confidence in anybody;
I have no confidence at all in you," they often say to
me; and yet you can make them see through hallu-
cinations all you wish. They are incapable of voluntary
obedience, which demands strength of mind, and they
undergo in a sickly sort of way all automatic impulsion.
Thus we have admitted that suggestion cannot develop
in sickly minds, that it demands, in order to attain to its
full power, minds relatively sane. But we have just
now demonstrated that it depends on a lack of synthesis,
on a weakening of consciousness. Are not these two
affirmations contradictory? A symptom may dis-
appear in certain maladies and still remain a patho-
logical symptom. The same with suggestion: it does
not belong to all mental disorders, but it is the sign of a
particular mental disease. It is necessary for its oc-
currence that the automatic association of the psy-
chological elements be preserved, and that the actual
Hysterical Stigmata — Suggestibility 289
synthesis of the phenomena be altered or reduced.
It requires as its essential condition a malady of the
personality.
It must be confessed that there is a particular disease
which unites in a wonderful manner the two essential
conditions of suggestion, which are the preservation of
automatism and the diminution of personal synthesis;
this is the hysterical state. The study of all the accidents
has constantly shown us these two characteristics in
hysteria. A tendency to suggestion and subconscious
acts is the sign of mental disease, but it is, above all, the
sign of hysteria.
Let us take another point of view, and consider all
the patients we clinically regarded as hysterical. I
say that you will almost always find again in them, with-
out difficulty, all the phenomena of suggestion. First
of all you will find them experimentally. If you set
aside the old quarrels and examine calmly all the
subjects who have been presented as fine examples of
suggestion, you will first see that most of them are
I somnambulists. Do not forget, in fact, that it is in the
\ hypnotic state that suggestion was first described. Now,
li the hypnotic state is nothing but the reproduction of a
\ hysterical somnambulism, and, I do not hesitate to add,
lj in a hysterical subject. Next, it has been shown that
1 suggestion exists in the waking state with these same
subjects, susceptible of presenting hypnotism. There
is no need to demonstrate this diagnosis.
Then, suggestibility has been shown from time to time
in individuals who were not and had not yet been hyp-
notized. Mistrust these observations; you must first
290 The Major Symptoms of Hysteria
ascertain whether the suggestions indicated were real
suggestions, whether the observer, with his preconceived
ideas, was not content with some naive obedience or,
alas, with some comedy. But, if the fact is true, and
it is sometimes so, examine the individual clinically,
and I assure you that you will have no difficulty in
recognizing that he is hysterical. For my part, I have
never seen a fine suggestible subject who was not
clearly hysterical, and, inversely, I have been able to
make all the experiments of suggestion on the subjects
who, on the other hand, had decided morbid accidents.
Inversely, this relation between suggestibility and
the hysterical neurosis can be verified in the clearest
manner by studying the disappearance of suggestion.
In fact, as suggestion does not exist with everybody,
so you must not fancy that it constantly exists during all
the life of the hysterical. There are many circum-
stances in which the suggestibility of hysteria tends to
disappear. What is most interesting in this connection
is that it disappears completely when the disease is
cured. A great number of those persons, after having
kept for some time both the accidents and the mental
dispositions that characterize this neurosis, recover
completely. Well, at that moment, suggestions no
longer take, and these subjects bear themselves in
regard to suggestions like normal individuals. This
is a very important fact, which I have already pointed
out in connection with hypnotism. I have described it
these twenty years, and the theoreticians, who will
absolutely find hypnotism and suggestion in everybody,
have never replied a word to this argument.
Hysterical Stigmata — Suggestibility 291
Besides, there are other circumstances in which the
hysterical recovers, at least partially, for it is a very
changeable malady. In certain periods of rest, of
health, in certain somnambulisms, or in that which has
been wrongly called the second state of Felida, we have
seen that the hysterical states disappear. You will
likewise recognize that the suggestibility disappears.
This symptom only reappears in a state of depression,
together with all the other accidents. I described, long
ago, those women who are suggestible only three days
a month, during their menstrual period. Experimental
suggestion has never existed with any persons but with
hystericals.
By the side of this experiment you may place real
non-experimental suggestions, which occur accidentally
and are often the cause of accidents. I mean those
accidents with which the patients are inspired by the
events of their lives, and which, by developing themselves
to an exaggerated degree, bring about attacks, paralytic
accidents, or singular visceral diseases. Malebranche
related in the seventeenth century the story of a woman
who, because she had seen a rider dragged by the foot,
had a disease and a paralysis in her foot. We con-
tinually see facts of this kind nowadays. One patient
has an amaurosis in her left eye because she has seen
a child with scabs on its left eye, and another vomits
incessantly because he has nursed a cancer of the
stomach. In all these cases, if you examine the evo-
lution of the disease, its symptoms, the accidents that
preceded it, I do not hesitate to assure you that you will
always find again the same neurosis.
292 The Major Symptoms of Hysteria
In a word, my opinion on this point has become
more and more definite. Suggestion is a precise and
relatively rare phenomenon ; it presents itself experi-
mentally or accidentally only with hystericals, and,
inversely, all hystericals, when we study them from
this standpoint, present this same phenomenon in a
higher or lower degree. If we add that, as we shall see
later, this psychological fact plays a great r61e in the
formation of their disease, we may say that the most
important mental stigma of hysteria is suggestibility.
We have still to ask ourselves whether there are not
other mental stigmata to be added to this one.
V
LECTURE XIV
THE HYSTERICAL STIGMATA — THE RETRAC-
TION OF THE FIELD OF CONSCIOUSNESS —
THE COMMON STIGMATA
Other proper hysterical stigmata — Absent-mindedness —
The contraction of voluntary movements — Subconscious-
ness — Transfers and equivalences — Alternation — The
elementary phenomena of consciousness — Personal percep-
tion — Conscious synthesis — The field of consciousness —
7/5 variations — The retraction of the field of conscious-
ness — The common stigmata — The feelings of incom-
pleteness — The need of excitation — The need of attract-
ing attention — Lapses of the mental functions — The
weakness of attention — Emotional disturbances — Troubles
of the will — The incapacity of beginning or of stopping
— The lowering of the mental level
THE r61e played by suggestion in hysteria is beginning
to be known, and I shall no longer raise too many
protestations by presenting to you suggestion as a hys-
terical stigma; but I think it is well to go farther.
We should not explain the whole of this so complex
disease by this single phenomenon. For the present,
I confine myself to remarking that, in the mental dis-
positions of these patients, there are to be found other
facts of at least equal importance. These other funda-
mental phenomena are also stigmata to my mind.
Only I propose to you to divide them into two classes.
293
294 The Major Symptoms of Hysteria
Among these stigmata, some deserve to be called proper;
they have the same properties as suggestion itself.
They are phenomena that exist in hysteria, but scarcely
exist in any other disease. The others might be called
common stigmata, for the following reason. No doubt,
they present themselves among hystericals, and often
in a high degree, but they do not exist solely among
these patients, and they are to be found in other mental
affections, in particular in the psychasthenic neuroses,
which are closely akin to hysteria, though different
from it. Let us dwell on the other stigmata proper,
which are added to suggestion, and devote a few words
to the common stigmata, which allow us to connect the
neurosis we consider with the other disturbances of
the mind.
Suggestion, let us not forget, is the development of
an idea ; it implies a positive phenomenon, the presence
of an idea in the mind of the subject. We cannot con-
nect with suggestion things that take place without the
subject's being at all aware of them, without his realizing
them either consciously or subconsciously. Now, I do
not believe that everything in hysteria is in relation
with the thought of the subject. There are in these
patients attitudes, dispositions that not only are not
intentional but that are in relation with no thought of
the patients.
I should like to put in the first rank of these phenom-
ena a very singular disposition of mind, for which we
have not even a very clear expression ; namely, a dis-
The Hysterical Stigmata 295
position to indifference, to abstraction, to quite ex-
aggerated absent-mindedness. The fact is this: while
paying attention to something, we turn from some other
thing and cease to interest ourselves in other phenomena,
which however reach our minds. While I am paying
attention to what I am reading, I abstract myself from
the noises in the street, though I still perceive them.
This abstraction exists in hysteria in an astonishing
degree. It was noticed early that it presents itself in
regard to the sensations and to ideas. These patients
appear to see but one thing at a time, and you become
aware that they have no notion of another object,
though it be very near the first. When they speak
to one person, they forget that there are others in the
room. They forget them so entirely that they would
tell all their secrets before them with indifference.
When they express some idea, you notice that their
conviction is childish. It seems very strong because
it rests on an astonishing ignorance. Objections,
impossibilities, contradictions, do not reach their minds
in the least.
The same limitation was observed in their move-
ments from the first. They can perform but one action
at a time. The first indication you perceive of a mental
disturbance with many girls is their incapacity to do,
in spite of their good-will, more than one errand at a
time. This fact may even be made in some sort experi-
mental. Here is an experiment that I have described
under many forms l and that M. Pick, of Prague,
1 " L'Automatisme Psychologique," 1889, p. 188 et seq. "The
Mental State of Hystericals," English translation, p. 161.
296 The Major Symptoms of Hysteria
has developed.1 You ask one of these patients to make
a certain movement continually, for instance to make
on the table with her right hand the movement of playing
on the piano. It is agreed that she must not discontinue
this little movement, whatever may happen. At the
same time, you ask her to perform some other simple
acts, to open her mouth, to shut her mouth, to recite
numbers. You always remark that the first movement,
the piano playing, stops as soon as the second begins,
and that it only recommences at the end of this second
movement. Yet the subject had made up her mind to
continue this movement, she had this idea in her head,
but it became impossible for her as soon as she tried to
do something else.
It is this, besides, that gives a special appearance to all
their accidents. By the side of the positive phenom-
enon, consisting in the development of the somnambulic
idea, in convulsions, in persistent emotions, there was
a kind of lacuna, a complete oblivion of the present
situation, an indifference to ridicule, an insensibility
to fatigue, all of which we should not have had in their
place. One would think that these subjects, when once
ill, forget all that is outside their present accident.
They do not remember having been in another state,
they do not conceive that one can be in another state.
Hence that resignation, that absence of effort, which
surprised us.
The exaggeration of this disposition will bring about
the phenomenon of subconsciousness : a great many
1 A. Pick, " Ueber die Sogenannte 'Conscience Musculaire/"
Zeitschrijt jiir Physiologic der Sinnesorgane, IV, 1892.
The Hysterical Stigmata 297
things will exist outside the personal consciousness.
You will be able to make the patients walk and act
unknown to themselves. If the ideas you express do
not attract their attention and if they remain in that
domain of absent-mindedness, it will result in medium-
ship, as we saw before that the development of the
ideas results in great somnambulisms.
Can we say that this disposition to exaggerated absent-
mindedness is a consequence of the preceding symptom
of suggestion ? In fact, it is not so, for absent-minded-
ness is not suggested to these patients and often is not
even noticed. They have not the idea of this phenom-
enon, the importance of which they do not suspect.
This singular absent-mindedness is mostly noticed by
those around them, or by themselves only very late,
several years after it has begun to develop itself. On
the other hand, it is difficult to understand how sug-
gestion, which is precisely the development of an idea,
could explain this absent-mindedness, which is indif-
ference to an idea, a tendency to suppression. Lastly,
suggestion itself appears to me to depend on that
disposition, and to be much oftener its effect than its
cause. It is precisely because the subjects have for-
gotten everything, because they are no longer restrained
by any sensation, by any thought relative to the reality
that surrounds them, that they allow the ideas suggested
to them to develop freely. Suggestion and absent-
mindedness do not produce each other, they are two
parallel stigmata, one of which cannot exist without
the other.
This special absent-mindedness is a stigma peculiar
298 The Major Symptoms of Hysteria
to hysteria. First of all, you do not find it in the normal
individual. Normal consciousness, as philosophers
say, is always a fully illuminated point, surrounded by
a strong penumbra. With the hysterical, the penumbra
is wanting. This fact is brought into evidence by their
quite peculiar visual field ; you do not find in any normal
individual that odd vision, which sees very clearly
in one point and sees nothing around this point. Nor
is this absent-mindedness to be met with in the same
fashion in the other maladies of the mind. Individuals
who are tired are inattentive, but their minds are vaguely
on the stretch. No doubt, they search into nothing,
but they have a vague notion of everything. Their
sensibility is attenuated, I grant, but it is distributed
over the whole of their body. Their vision is di-
minished, but their visual field remains broad. In a word,
the symptom I wish to describe to you is not inattention ;
it is a suppression of all that is not looked at directly,
and I do not believe that it is to be found in this form
in the other diseases of the mind. So I make it a stigma
proper to hysteria as suggestion itself.
A third phenomenon, which, besides, depends on the
preceding ones, will make you understand these strange
stigmata still better. It is the phenomenon of transfers
and equivalences. I was seeking one day to cure a small
localized accident, to restore the motion of the right
wrist with a patient whose fist was contractured. You
know that, to succeed, one must strongly direct the
attention of the subject to the diseased organ, which
she has forgotten, determine sensations in it, move
it passively in every way; then, when the motion has
The Hysterical Stigmata 299
been a little restored, induce the subject voluntarily to
move this wrist. This work is long and troublesome,
and has to be begun over and over again with hystericals.
When it has proceeded for some time, the result seemed
marvellous; the right hand had opened and moved
freely in every way, the patient left the laboratory very
happy and proud. She reentered it a few moments
later in despair. "It was not worth while making such
efforts," she said, presenting her left fist, which was
contractured exactly in the same way as her right fist
had been a few minutes before. I have cited this ad-
venture because it struck me by the circumstances in
which it occurred ; namely, in a quite na'ive patient,
having no notion of the phenomenon, and without the
operator or herself having had the least idea of it, before-
hand.
You know that the result is not always like that.
During a certain period, from 1875 to 1890, this phenom-
enon, which is called transfer, was very much sought
after and often provoked artificially. It was said to
be brought about by the mechanical action of certain
substances. Thus the magnet had preeminently the
power of provoking transfers. To cure a paralysis
of the right side, a big magnet was placed in the bed
of the patient, near her right side. The paralysis was
then found to disappear on that side and to become
localized on the left side. When the magnet was with-
drawn, the paralysis reappeared on the right side, and,
after several oscillations of this kind, it vanished.
Other substances — metals in particular, sometimes the
electric current — had similar effects, and transferred
300 The Major Symptoms of Hysteria
symmetrically from one side to the other the disturbances
of sensibility as well as those of motion. You remember
that this phenomenon was very much studied by Burcq
and Dumontpallier, who ascribed to it very odd laws.
Some physicians said they had found the means to make
the oscillations either slow or rapid, to fix the disturb-
ance on one side or the other, etc. Others went even
further; they invented the change of the colour sensa-
tions, which were transformed into their complementary
colours. The patients, after having seen red, saw
green ; after having seen yellow, they saw violet. They
called this polarization, and, by means of the magnet,
tried to polarize also the feelings. Lastly, — for absurd-
ity has no limits, — they tried to transfer a phenomenon
from one subject to the other ; they placed two subjects
back to back, and, thanks to the magnet, the paralysis
of the first passed into the second, and, after a few os-
cillations, disappeared. It became a convenient thera-
peutic process.
No doubt there are in all this many childish errors.
Many of these observations are phenomena of suggestion
and training, they depend on the direction that is
given to the attention of the subject. This could not
but be gradually recognized, so that, in science as in
politics, we saw a violent reaction. The very notion of
the phenomenon of transfer was suppressed, and the
fact that there is some little truth in it was overlooked.
In my opinion, this passage of an accident from one side
to the other is not necessarily the result of a suggestion.
It sometimes takes place unknown to the subject and
to the operator, and that very naturally.
The Hysterical Stigmata 301
It is a particular application of a disposition which is
very general with the hysterical, and of which a thou-
sand other applications are to be observed; namely,
the disposition to equivalences . Hysteria, in fact, is a
very singular malady, the cure of which one never dares
assert. It is often easy, through some psychological
process or other, to cause such or such a determinate
accident to disappear. Besides, these accidents often
disappear of themselves, in consequence of an emotion,
of some shake, or even without reason. But, when an
accident has disappeared, especially when it has dis-
appeared too quickly, we should not at once cry out
victory. First of all, the same accident is very likely
to soon reappear. Then the following strange thing
very frequently occurs: another apparently quite dif-
ferent accident takes the place of the first. A girl of
twelve presented incoercible vomitings, which had
brought her to a very serious state of inanition. Thanks
to certain excitations of the sensibility during a sornnam-
bulic state, I succeed in making her eat with more
sensibility, in regularizing her deglutitions, and she no
longer vomits. This seems all right, but, from that
moment, this girl, till then perfectly intelligent, enters
into a state of mental confusion and delirium, and it
becomes impossible to stop this delirium without the
vomitings beginning again. Let us remark by the way
that this singular alternation between disturbances of
the stomach and deliriums is one of those that are oftenest
observed. I have noted down five fine examples of
them.
But other identical facts are to be observed. One
3<D2 The Major Symptoms of Hysteria
patient has contractures in her limbs, and, when the
contractures disappear, mental disturbances; another
has hysterical coughing, and, alternating with it, crises
of sleep. A man had a foot contractured in the position
called varus. He was cured through somewhat mys-
terious processes, which frightened him. He could
now walk freely, but he lost his voice for three months.
When his voice returned, he had gastric accidents and
abdominal contractures. In another case, the con-
tractures of the trunk were healed and replaced by
phenomena of amaurosis. And so on indefinitely.
The accidents seem to be equivalent and to have the
property of bearing on one side or the other, provided
they exist somewhere. You would think that the sub-
ject can choose but cannot do without a disturbance
localized in some place or other. If you understand
this law of equivalences well, you will see that the
transfer from the right side to the left side is but a
particular case of it. It is even a particularly simple
form of equivalence, for the sensations of the sym-
metrical parts are very similar and can very easily
be replaced by one another.
No doubt, in many diseases of the mind, we observe
instability, but this quite special form of instability
which replaces one definite accident by another ap-
parently quite different, and that suddenly and clearly,
is, again, very characteristic. I think it results from a
general disposition of the hysterical mind, which urges
it to move in its entirety to one side, while neglecting the
rest of the body and mind, then to move in its ensemble
in another direction, while forgetting the first. This
The Hysterical Stigmata 303
is connected with the preceding phenomenon of sug-
gestion, and constitutes the last of the stigmata peculiar
to hysteria that I wished to point out to you.
II
Can we summarize these three stigmata, suggestion,
absent-mindedness, and alternation, into a single
general idea that will enable us to conceive the essential
character which manifests itself in these mental troubles ?
I proposed formerly to characterize this mental state
by an expression that is perhaps singular, but that may
be serviceable. You will find it in my work on the
psychological automatics in 1889 and in my book on
" The Mental State of Hystericals," 1894, which was very
well translated into English by Mrs. C. Rollin Corson
in 1901. I proposed to summarize this somewhat
peculiar mental state by the words "retraction of the
field o] consciousness." Let us try to understand the
meaning of this general expression.
The word "consciousness," which we use continually
in studies on the mental state of our patients, is an
extremely vague word, which means many different
things. When we use it in particular to designate the
knowledge the subject has of himself, of his sensations
and acts, it means a rather complicated psychological
operation, and not an elementary and irreducible opera-
tion, as is generally believed. If I say, for instance, " I
feel a pain, I feel that I move my arm," there take place
in my mind rather complicated phenomena, which we
can analyze in the following manner. In the first place,
304 The Major Symptoms of Hysteria
there occurs somewhere in my brain, on the occasion of
an outer excitation, a small fact, both physiological
and psychological, which corresponds to a phenomenon
of pain, to an elementary sensation of motion. The
great physiologist Herzen said that the brain may be
compared to a spacious hall filled with innumerable
small electric lamps. From time to time, certain little
FIG. 21. — T T' T", elementary sensations of touch; M M' M", of mus-
cular sense; V V V", of vision; A A' A", of audition; P P, personal
perception.
lamps kindle here and there. This is what is des-
ignated by the isolated words, "sensation of pain,"
"sensation of vision," "sensation of motion." In the
scheme I have drawn (Figure 21), each separate little
cross of the upper line designates one of those little phe-
nomena, V) V, V", when it is a question of the vision,
T, Tf, T", when it is a question of the sensations of
touch, and so on.
But the complete consciousness which is expressed
by the words, "I see, I feel a movement," is not com-
The Hysterical Stigmata 305
pletely represented by this little elementary phenomenon.
It contains a new term, the word "I," which designates
something very complicated. The question here is
of the idea of personality, of my whole person ; it is
the union of present sensations different from the little
sensation considered, from all past impressions, from
the imagination of future phenomena. It is the notion
of my body, of my capacities, of my name, of my social
position, of the part I play in the world ; it is an ensemble
of moral, political, religious thoughts. It is a world of
ideas, the most considerable, perhaps, that we can ever
know, for we are far from having made the tour of the
domain of personality. There are then in the "I feel,"
two things in presence of each other: a small, new,
psychological fact, a little flame lighting up — "feel " —
and an enormous mass of thoughts already constituted
into a system — "L" These two things mingle,
combine; and to say "I feel" is to say that the already
enormous personality has seized upon and absorbed
that little, new sensation which has just been produced.
If we dared, and it is not altogether absurd, we should
say that the "I" is a living animal, extremely voracious,
a sort of amoeba, which sends out tentacles to seize
and absorb a very small creature which has just been
born at its side.
After having represented in the first line of our
schema the elementary sensations, or affective states,
or simply subconscious phenomena, we represent,
secondly, a reunion, a synthesis of all these elementary
phenomena which are combined among themselves,
and particularly combined with the vast and prior
306 The Major Symptoms of Hysteria
notion of personality. It is only after this sort of
assimilation that we can truly say, "I feel." I formerly
proposed to designate this new operation by the name
of personal perception, P.P., for it is indeed a perception,
that is to say, a clearer and more complex consciousness.
The word "personal" will prevent confounding this
operation with the outward perception, of which we do
not treat here, and will recall to mind that its essential
character is the addition of the notion of personality.
This figure is, of course, quite theoretical, for it sup-
poses an absurd thing; namely, that a man becomes
at a given moment conscious of, assimilates to his per-
sonality, all the elementary sensations that are born
in all his senses. Think what enormous masses of
phenomena must spring up in us constantly from all
the points of our body, from the crowd of impressions
made on our skin, on our mucous membranes, on the
organs of our senses, by all the outer and inner phe-
nomena. It is certain that a man never perceives them
all. There are always, even in the most normal man,
a quantity of impressions that are born in one point
of the skin, reach to the brain, determine a few re-
flexes, awake perhaps a few little states of elementary
consciousness, contribute, no doubt, to his general state
of well-being or discomfort, but are not clearly per-
ceived by his personality. A part only of these ele-
mentary sensations gives rise to complete and personal
perception.
What is the number of those elementary phenomena
that rise to complete consciousness ? Of how many ele-
mentary sensations can we simultaneously have the
The Hysterical Stigmata 307
complete consciousness? This is what I proposed to
call the problem of the extent of the field of conscious-
ness, by analogy, as you see, with the extent of the visual
field. This problem is not clearly resolved, and psy-
chologists have proposed very different figures.
The only essential and certain thing is that this extent
of the field of consciousness varies very much with
individuals and their states of mind. An orchestral
conductor, hearing simultaneously all the instruments,
and following by reading or by memory the score of the
opera, unites in each of his states of consciousness
an immense number of facts. The individual who,
when asleep, dreams, and the patient during a crisis of
ecstasy, have, on the contrary, in their conscious thought
a very limited number of facts. I think there are on this
point perpetual and very nice variations of our mental
state.
If you understand this psychological conception well,
you can easily apply it to the preceding phenomenon
that we have just noted with our hysterical patients.
Their first moral stigma, suggestion, already shows us
the isolation of the ideal; it is because there is no re-
action between the various impressions that each word,
each emotion, each remembrance, takes an inordinate
development which we called suggestibility. Sug-
gestion, it is always said, depends on the absence of
control. But control is nothing but the struggle, the
competition of the various psychological states united
in the same consciousness. If it is wanting, it is
because the mind is too narrow to contain several ideas
opposing one another. The second characteristic,
308 The Major Symptoms of Hysteria
exaggerated absent-mindedness, that abstraction bring-
ing on all the blanks of consciousness, is but another
aspect of the same phenomenon.
Our schema gives us the formula perfectly. Let
us suppose (Figure 22) an individual who cannot see, at
£
$
A'
A'
4-
FIG. 22. — Schema of absent-mindedness.
a given moment, more than three elementary sensations,
such as V, V, A . He will leave all the rest in his sub-
consciousness. At another moment, he will be able
to turn to T, Tr, V, or to M , V, A . At the first moment,
he will look at, and listen to, a person who speaks to him,
without troubling about the tactile sensations which
continue to assail him. At the second moment, he will
The Hysterical Stigmata 309
look at an object while touching it, and appreciate the
contact without having consciousness of the surrounding
noises. At the third moment, he will write at dictation,
having the perception of the sound of the voice, of the
vision of the letters and of the muscular movements, but
forgetting and neglecting all the other elementary
sensations, as T, T', T" , M', M", V, V", A', A". This
individual is absent-minded, and this (Figure 22) is an
attempt to schematize what is called normal absent-
mindedness.
Let us suppose that the field of consciousness becomes
still more contracted. The patient can no longer
perceive more than two elementary sensations at once.
Of necessity too, he reserves this small share of per-
ception for the sensations which seem to him, whether
right or wrong, the most important, the sensations
of sight and hearing. To have consciousness of what
is seen or heard is of paramount necessity, and he
neglects to perceive the tactile and muscular sensations,
thinking he can do without them (Figure 23). At the
outset, he might perhaps still turn to them and take
them into his field of personal perception, at least for
a moment; ,but, the chance not presenting itself, the
bad psychological habit is slowly formed. Nothing is
more serious, more obstinate than these moral habits.
There is a crowd of maladies that are only psychological
tics. One day the patient (for he has truly become
one now) is examined by the physician. The latter
pinches his left arm, and asks him if he feels it, and the
patient, to his great surprise, is obliged to confess that
he can no longer feel consciously. The too long-neg-
310 The Major Symptoms of Hysteria
lected sensations have escaped his personal perception ;
he has become anesthetic.
You may easily understand that the same notion of
the contraction of the field of consciousness equally
T T' T" M M' M" V V' V" A
T'
M
-t-
T'
•*-
M
FIG. 23. — Schema of the contraction of the field of consciousness in
hysterical anesthesia.
sums up the last phenomenon, that of alternations. It
is because the field of consciousness remains contracted,
that you can never add one phenomenon on one side
without taking one away from another side. If you
force the subject, by attracting his attention, to recover
The Hysterical Stigmata 311
the sensibility of the left side, he loses it on the right side.
If you obtain the total tactile sensibility, the reduction of
the visual field increases so much that the subject
becomes momentarily blind, a thing we have observed
a number of times without having foreseen it. If you
wish to enlarge the visual field, the tactile anesthesia
will increase. The feebleness of these patients' thinking
continues, and they lose on one side what they seem to
have regained on another.
I am therefore inclined to think that this notion of the
retraction of the field of consciousness summarizes the
preceding stigmata, and we may say that their funda-
mental mental state is characterized by a special moral
weakness, consisting in the lack of power, on the
part of the feeble subject, to gather, to condense his
psychological phenomena, and assimilate them to his
personality.
Ill
Formerly I stopped at this point my description of the
hysterical mental state, implying that all the other
disturbances of their character could be connected
with the preceding ones. It no longer seems to me
absolutely true to-day. The hysteric malady is not
absolutely isolated, like other mental disturbances. It
is a special form, which constitutes a part of a much more
considerable group, and which is more or less distin-
guished from the other diseases belonging to this group.
The patients we consider are first and above all neuro-
paths, individuals whose central nervous system is
weakened; then they are hystericals, when their en-
312 The Major Symptoms of Hysteria
feeblement takes a particular form. I even affirm that
they are more or less hysterical according as their malady
takes a more or less decided turn in this determinate
direction. The result is that, besides the properly
hysterical stigmata, they have general vague disturb-
ances, at once psychological and physiological, which
belong to all neuropathic individuals. We cannot enter
into the enumeration of these disturbances, which,
besides, would be more interesting in connection with
other subjects, but we must indicate them shortly under
the title of common stigmata which you understand now.
I will point out to you in this connection certain feel-
ings that play a r61e in the popular conception of hysteria.
These subjects feel weak, dissatisfied with themselves;
their actions, ideas, feelings, appear to them reduced,
covered with a kind of veil. They are, therefore, per-
petually tormented by a vague ennui which they cannot
overcome. Ennui is the great stigma of all neuropaths.
You must not believe that it depends on surroundings;
the neuropath feels dull everywhere and always, for
no impression any longer brings about with him lively
thoughts that make him pleased with himself.
These general sentiments of dissatisfaction, these
sentiments of incompleteness, as I have christened them
elsewhere,1 almost always give to the patient a peculiar
attitude or conduct. Either he is sunk in despondency
and exhibits a doleful air, or he seeks everywhere for
something that can draw him out of this state. Now
he has but very few means at his disposal to rouse
himself, to come out of such a painful state. Either
1 " Obsessions et psychasth^nie," 1903, I, p. 264.
The Hysterical Stigmata 313
he will use physical and moral processes of excitation,
walking, jumping, crying, or he will appeal to other
persons, and will incessantly ask them to excite him, to
revive him through encouragements, through praises,
and especially through devotion and love.
You see what will result from these needs. These
patients will be, at the same time, plaintive and
agitated, they will commit all kinds of eccen-
tricities, because eccentricity excites them and draws
attention to them. They must needs attract atten-
tion to themselves, in order that people may take
an interest in them, speak to them, praise, and, above
all, love them. This need of attracting attention,
of being praised and loved, is one of the things that have
been most remarked. In my opinion it has always
been wrongly interpreted.
First of all, it is a clinical error to ascribe this char-
acter to hysteria. It sometimes exists in a very high
degree with hystericals, but it is by no means a stigma
peculiar to this malady; it exists as well in the psy-
chasthenic. The amorous manias of doubters and of
patients laboring under obsessions, their mania of
jealousy, their need of attracting attention to themselves,
are often much stronger and especially more enduring
than with hystericals. This remark has very often
caused errors of diagnosis.
Besides these feelings of incompleteness, we might
enumerate with our hystericals, as with all neurasthenics
whatsoever, the innumerable lapses of all the mental
functions. We note in the intelligence a certain ap-
parent vivacity, associated with a fundamental state of
314 The Major Symptoms of Hysteria
laziness and especially of reverie. These patients pay
attention to nothing, can bear no mental work. Hys-
teria, like all neuroses, begins, among girls, with the
cessation of their studies and the complete incapacity of
learning anything. In fact, this incapacity of attention
brings with it, as a consequence, the absence 0} memory.
Events are not fixed in the mind. Whereas old remem-
brances relating to periods previous to the malady are
well preserved, and are even reproduced with an exag-
gerated automatism, recent events pass without leaving
any trace. It is a disturbance of the memory, which I
have described under the name of continuous amnesia.1
It is frequent with hystericals, but it is not proper to
them and it must be considered only as a common
stigma.
The same alterations are found in the feelings, which
are weakened. The subjects, who seem so emotional,
in reality feel nothing vividly. They are indifferent
to all new feelings, and confine themselves to reproduc-
ing with an automatic exaggeration a few old feelings,
always the same. Their emotions, which seem so vio-
lent, are not just ; that is to say, they are not en rap-
port with the event that seems to call them up. You
always hear the same cries, the same declamations,
whether the question is of a surprise or of a happy or
an unfortunate event.
Lastly, the disturbances of their will are well known.
The patients no longer will or rather they can no longer
do anything. They can no longer make up their minds
to anything, hesitate indefinitely before the least thing.
1 "Ndvroses et Id&s fixes," I, p. 109.
The Hysterical Stigmata 315
I think, even, that they can no longer make up their
minds to sleep, and, in many cases, the so serious
insomnia of neuropaths is a phenomenon of abulia,
for they cannot even make up their minds whether they
will remain awake or asleep. Of course, it is especially
new actions that will become difficult and, for a long
time, the patients go on with old actions, without being
able to stop, before they enter a state in which they no
longer do anything.
This incapacity of beginning an act or an effort of
attention, and this incapacity of stopping it when it
is once begun, bring about the most serious disturb-
ances. Most of the accidents might easily have
been stopped at the outset. We begin to dream be-
cause we wish to do so, reverie is so pleasant. We
begin to eat sparingly in order to be thin, to have a
small waist, and not to look like mamma. We begin an
annoyance, get into tantrums, but we were provoked to
it. All this, as the patients will themselves confess,
might have been very easily stopped at the beginning;
but the act continues more and more automatically,
and the patient can no longer stop it herself. It be-
comes a delirium, an anorexia, and an attack. "When
I have begun something," we heard a patient say,
"I must go on with it; I cannot stop. I would break
the windows, kill myself. I fall into an idea as down a
precipice, and the declivity is hard to climb again."
No doubt you will find all these phenomena of abulia
with all neuropaths. But that is not a reason for neg-
lecting them with hystericals. They constitute with
them common stigmata which add themselves to their
316 The Major Symptoms of Hysteria
proper stigmata, and, besides, often assume a particular
aspect under the influence of the latter. It is easy to
summarize, in a word, these general disturbances of
neuropaths. It is a mental depression characterized by
the disappearance of the higher functions of the mind,
with the preservation and often with an exaggeration
of the lower functions; it is a lowering of the mental
level. So we may say, in short, that hystericals present
to us the following stigmata : a depression, a lowering
of the mental level, which takes the special form of a
retraction of the field of consciousness.
LECTURE XV
GENERAL DEFINITIONS
Review of the typical symptoms of hysteria — The positive
and negative phenomena in somnambulism with amnesia,
in agitations with paralyses and anesthesias — The general
idea of the contraction 0} the field of consciousness and of
the lowering of the mental level — Definitions of hysteria —
Their congruency — Psychological definitions — The need
of precision in these definitions — Definitions of hysteria
as a disease by suggestion — Discussion of these defi-
nitions — Fixed ideas, without relation to the medical form
of the accident — The physiological and psychological laws
unknown to the patient — The conditions of suggestion —
Hysteria as a form of mental depression, characterized by
the contraction of the field of personal consciousness and
a tendency to the dissociation and emancipation of the
system of ideas and functions that constitute personality —
The laws of localization — The part played by the diffi-
culty of the junction, by psychological automatism, by the
anterior weakening of the junction, by the localization of the
emotion
IN these lectures on the great symptoms of hysteria,
I have tried to present a rapid picture, not of all the
symptoms of hysteria, but of the essential ones, in order
that you might form a just idea of a singular malady,
of which everybody speaks and which but few physicians
know well. I have only presented to you the typical
3i 8 The Major Symptoms of Hysteria
cases and forms, around which it is easy for you to group
the degraded forms and confused aspects which most
diseases offer in practice. We must try now to sum up
these descriptions and to derive from them some general
conception of the whole disease.
Allow me, first, to remind you in a few words of the
essential pictures you should keep before your eyes
in order to form a general idea of the hysterical disease.
We have studied somnambulism together. I no longer
say " hysterical somnambulism," for there is no more any
somnambulism for us, outside of hysteria. We have
studied it under its simple and typical form of mono-
ideic somnambulism, then in its more complete forms
of fugues, of polyideic somnambulisms, of artificial
somnambulisms. You remember that we have always
recognized in it the exaggerated development of an idea,
of a feeling, of a psychological state, in a word, of a
system of thoughts, which takes place outside the
memory and the normal consciousness. This dis-
sociation of a psychological system is manifested not only
by the preceding development, but also by amnesia, bear-
ing not only on the somnambulic period, but even, in re-
markable cases, on the whole of the idea and of the feeling.
When later we studied various accidents bearing on
the movements of the limbs, we recognized that small
systems of movements, and sometimes great systems,
rich and old, constituting real functions, develop
themselves without control to an exaggerated degree,
General Definitions 319
and give rise to tics and choreas of various kinds.
This lack of control is manifested through negative
phenomena ck>sely connected with the preceding ones,
paralyses and anesthesias, which seem to play here the
same r61e as the amnesias of somnambulism. When
we came to the sensorial functions, we saw the same
agitations under the forms of tics, of pains, and of hal-
lucinations, accompanied with certain losses of control
which constitute various anesthesias bearing on the
special senses as well as on the general sensibilities.
In connection with these anesthesias, we remarked
more clearly than we had done in connection with the
preceding phenomena, the real nature of these amnesias,
of these paralyses ; in a word, of these disappearances
of functions. The function is far from being destroyed.
It continues to exist and often even develops to an
exaggerated degree. It is only suppressed from one
very special standpoint ; it is no longer at the disposal
of the will or the consciousness of the subject. Sur-
prising as it is, we recognized the same facts not only
in the complex function of speech, but even in the
visceral functions. The refusal to eat, vomitings,
hysterical dyspnoeas, are not diseases of the stomach
or lungs. They consist in a kind of emancipation
of the cerebral and psychological function relative to
these organs. There is now an exaggeration indepen-
dent of the function ; again and more often, a disappear-
ance from consciousness of these organic wants and of
the acts that are connected with them.
Finally, in our last lectures, we sought in the very
character of these patients, in the status of their minds,
320 The Major Symptoms of Hysteria
for fundamental stigmata allowing us to recognize and
understand the malady. We succeeded in bringing
into evidence, on the one hand, stigmata proper to hys-
teria : suggestion, absent-mindedness carried to uncon-
sciousness, alternation, which we summarized in the
general idea of retraction of the field of consciousness;
and, on the other hand, general stigmata, the absence
of attention, the lack of feeling and of will, which are
connected with depression, with the lowering 0} the
mental level.
This is a clinical picture that must suffice us in prac-
tice. If we remember these chief facts, by comparing
with them the complex and less clear cases that practice
presents to us, we shall succeed in appreciating the
hysterical disease fairly justly while avoiding many preju-
dices and errors that are still very common nowadays.
Unfortunately, the human mind is not so easily con-
tent; it is fond of dangers and quarrels, and we feel
the need of formulating concerning hysterical disease
general conceptions, interpretations, definitions, which
are much more exposed to criticism and error. It
seems to me that it is in some way a medical fashion to
give definitions on hysteria. Already, in the old book
of Brachet, in 1847, there were, at the beginning, about
fifty formulas passed in review. Though Lasegue
said that hysteria could never be defined and that the
attempt should not be made, since that declaration
everybody has tried to define it. I have discussed, in
my little book on hysteria, about ten definitions, and
I have been foolish enough to present a new one. Of
course, physicians have continued to define it, and, since
General Definitions 321
that time, ten others or so have been proposed. We
must obey the fashion by saying a few words about
these definitions. Let us try to derive from them,
without attaching too great importance to the terms,
a general idea that suffices us in practice.
n
I am wrong in laughing at the definitions of hysteria
and observing to you their abundance, which, in these
matters, is not a proof of truth. These definitions have
evolved ; they have made visible progress, and, though
they appear numerous nowadays, they come so close to
one another that they blend together. Do not forget
that we are speaking of medicine, and that this is rather
a special domain, less calm and serene than high math-
ematics. You should not ask too much of the virtue
of a physician, or hope that he will confine himself to
repeating the definition of a predecessor, even if he
does not cite his name. What would be left for him?
He must needs change something in these definitions,
were it but a single word, in order to appear to innovate,
which, in medicine, is indispensable. I do not exag-
gerate in telling you that, nowadays, three-fourths of the
definitions of hysteria are nearly identical.
Thus, I shall perhaps surprise you by telling you that
there is no opposition between the definitions that glori-
ously entitle themselves physiological and those that
modestly call themselves psychological. No doubt,
there would be a great difference if these authors had
seen, really seen, a lesion characteristic of the neurosis,
y
322 The Major Symptoms of Hysteria
and if they had connected the evolution of the disease
with this lesion. Never fear, one can make, nowadays,
a so-called physiological definition at smaller cost. It is
enough to take the most commonplace psychological
definitions and replace their terms with words vaguely
borrowed from the language of anatomy and the current
physiological hypotheses. Instead of saying, " The func-
tion of language is separated from the personality,"
one will proudly say, "The centre of speech has no
longer any communication with the higher centres of
association." Instead of saying, " The mental synthesis
appears to be diminished," one will say, " The higher
centre of association is benumbed," and the feat will be
done. I recommend to you in this connection to read
the last book of M. Jose Ingenieros, published at
Buenos Ayres, in 1906. In the first chapter, which
I do not understand very well on account of my imper-
fect knowledge of Spanish, he shows that many of
the definitions of modern physicians are equivalent,
and I am quite of his opinion. So there is an ensemble
of points on which all the authors agree, and it is those
which we shall have to bring into evidence.
Charcot used to say that hysteria is an entirely psy-
chic malady. This opinion was discussed at his time.
There were still some remainders of the old uterine
and genital theories; there were still some attempts
to connect hysteria with various nervous lesions. Dr.
Bastian's book,1 in England, a very interesting book,
is very courageous. He had the pretension to localize
1 Charlton Bastian, " Various Forms of Hysterical or Functional
Paralysis," 1893.
General Definitions 323
different hysterical accidents in different corners of
the medulla, of the bulb, or of the lower centres of the
encephalon. That there is no truth in those old con-
ceptions, that hysteria will not be recognized later as
resulting from some unknown disturbance of the se-
cretion of a vascular gland or from some lesion of a
nowadays badly denned nervous system, I should not
dare assert ; but one thing is certain ; namely, that for
twenty years everybody has departed from this view
of the matter, and that the psychological conception
has the mastery. I again observe to you that I consider
the pretended physiological definitions as mere trans-
lations of the psychological ideas. This point is almost
agreed on by every one.
But now, difficulties begin. Of what kind of psy-
chological disturbance is it a question? We should
not, under pretence of psychology, confusedly link
hysteria with the vague group of mental diseases and
the old nervosismus. On this point, the work of a
distinguished physician, Dr. Dubois, of Bern, inter-
esting from other standpoints, is, in my opinion, abso-
lutely pernicious. The psychological interpretation
should not suppress what is good, what is excellent, in
our ancestors' works. Now the last century produced a
monumental work; namely, clinical work. With infi-
nite patience and penetration, all those great clinicians
introduced order into a real chaos; they ranged the
diseases in groups, they enabled us to recognize these
groups. Improvements should consist in consolidating
this edifice and not in throwing it down. To say,
under pretence of psychology, that a somnambulism
324 The Major Symptoms of Hysteria
is identical with any delirium, that hysterical vomiting
is a mere derangement to be confounded with manias
of doubt or with melancholias, or even, perhaps, with the
tics of idiots, is to go two hundred years back, and it
would be much better to suppress the psychological
interpretation and be content with the clinical descrip-
tion. Consequently, in making hysteria a psychological
affection, we do not intend at all, as M. Grasset seemed
to believe, to confound it with some sort of other, or
mental, malady. We even say that it is nowadays the
most characteristic disturbance of all, and that it is
important to distinguish it well.
The first psychological notion that appears to me to
result with the greatest clearness from all the contem-
porary works is a notion relative to the importance of
ideas in certain hysterical accidents. Charcot, studying
the paralyses, had shown that the disease is not pro-
duced by a real accident, but by the idea of this accident.
It is not necessary that the carriage wheel should really
have passed over the patient ; it is enough if he has the
idea that the wheel passed over his legs. This remark
is easy to generalize. There are such kinds of fixed
ideas in somnambulisms and fugues ; the idea of one's
mother's death, the idea of visiting tropical countries,
etc. There are such ideas in systematic contractures,
for instance, when a patient seems to hold her feet
stretched because she thinks herself on the cross. There
are such ideas in visceral disturbances, and I have
shown you the observation of a patient who died of
hunger because she had the fixed idea of the turnips she
had eaten when at school. These remarks have been
General Definitions 325
well made on every side. It has also been established
that, with hystericals, ideas have a greater importance,
and, above all, a greater bodily action than with the
normal man. They seem to penetrate more deeply
into the organism, and to bring about motor and visceral
modifications. It is a point which was again emphasized
by MM. Mathieu and Roux, in a recent paper they
devoted to hysterical vomiting. "What characterizes
hystericals," they said, "is less the fact of accepting
some idea or other than the action exercised by this
idea on their stomachs or intestines."
At the same time, the studies on suggestion, which
have been very numerous, have allowed clinicians
to realize experimentally, through the action of ideas,
many phenomena analogous to hysterical accidents.
So it may be said that the most common conceptions
of hysteria turn on this character. Moebius in 1888,
after Charcot, said : "We may consider as hysterical all
morbid modifications of the body that are caused by rep-
resentations." Strumpell, in 1892, Bernheim, Oppen-
heim,and more recently, Babinski, have repeated each of
them, of course with a slight change in the words, quite
similar definitions. "A phenomenon is hysterical," said
Babinski, "when it can be produced through suggestion
and cured through persuasion." Let us take no account
of the end of the sentence. The treatment and cure
are delicate things ; much might be said on those cures
through persuasion. Let us only retain the beginning :
hysteria is defined by suggestion. It is absolutely the
conception of Charcot and Mcebius, hysteria through
fixed ideas and hysteria through representation. This
v
326 The Major Symptoms of Hysteria
word "suggestion," which, besides, one takes care not to
define, is taken simply in the sense attached to it by all
the preceding authors, namely that of a too-powerful
idea acting on the body in an abnormal manner. It is
easy to remark here a unity of a great number of con-
temporary conceptions.
Ill
I do not object very much to the preceding definitions.
If more precision were given to the meaning of the word
" suggestion," these definitions would be agreed on by
everybody. Besides, these definitions bring back all
the accidents of the neurosis to a symptom we have put
in the first rank among the stigmata, to the suggest-
ibility. So they are very scientific and useful. It is
one of the first results of all the psychological work that
has been done- on hysteria. However, I had already
discussed them hi 1894, and still think them insuffi-
cient. As my arguments have been very little contra-
dicted, I will try to formulate them more clearly.
In the first place, I believe that this conception of
hysteria is more just in theory than in practice. It rather
summarizes a systematic interpretation than the
clinical observation. It is we who have repeated that
the accidents seem to be brought about by ideas. It is
not quite exact that we always observe these ideas.
In a few cases — and they are always the ones that are
repeated — the patient, it is true, has the idea that he is
paralyzed. "I thought," he says, "that my leg was
crushed ; I had the idea that my leg no longer existed."
V
General Definitions 327
The consecutive paralysis with anesthesia of the limb
seems to be the exact translation of his idea. But it
is a singular exaggeration to apply this indifferently to
all hysterical accidents, and to say unreservedly with
M. Bernheim, "The hysterical realizes his accident
just as he conceives it." ->
This is to come back to a kind of contemptuous
accusation against the patient. Formerly, the physician
said to the patient: "You are paralyze^, you have
crises of sleep because you are willing to have these
accidents." Now, it is recognized that he is not willing
to have them, but it is still maintained that he thinks
of them. "You have such or such a crisis with such or
such an accident because you think of it." I say that
this is not true : there are many hystericals who do not
think of the accidents they have. First of all, with some
patients, the accidents develop insidiously, unknown to
them. They become anesthetic, paralytic, anorexic,
amaurotic, without in the least suspecting it. Clinical
practice shows you this every day. What shall we do,
then, with the observations already cited by Lasegue,
in which it is the physician who reveals to the subject
an anesthesia, or the blindness of one eye, which he
was not aware of. In other cases, it is incontestable
that the accident develops with details, with an evolution
that the patient does not know. Whatever M. Bern-
heim may say about it, I do not admit at all that hysteri-
cals have, at will, paralyses, with or without anesthesias.
I do not admit that these patients know what happens
in their somnambulisms, that they combine the disease
beforehand.
328 The Major Symptoms of Hysteria
If these patients have fixed ideas — and I acknowl-
edge that this is very frequent — it should be well
remarked that these fixed ideas have no relation to the
medical form of their accident. One has the fixed idea
of her mother's death ; it is not at all the fixed idea of
somnambulism and of its laws. Another has a fixed
idea relative to the flight of his wife, who robbed him ;
it is not the fixed idea of dumbness. Much oftener
than is believed, the accident develops independently
of the ideas of the subject, whether the subject does not
think of it or thinks of something else.
I should like to present, in the second place, an argu-
ment which is still weak, but the importance of which
will grow more and more. It relates to the physio-
logical and psychological laws of hysterical accidents,
laws of which we are ignorant, and of which the subjects
are ignorant like us. When we see a crowd of acci-
dents evolve according to these laws, which we painfully
describe, we cannot say that they are due to auto-
suggestion.
I remind you of the laws of somnambulisms, which,
in my opinion, are capital. Somnambulism is followed
by an amnesia which bears not only on the abnormal
period, but often also on the idea itself that fills it and
on all the feelings connected with it. This amnesia
disappears and all the apparently lost remembrances
are restored when the subject comes back into the
same somnambulism. In the case of Irene, which I
take as a type, there is in the waking state an amnesia
not only of the crisis, but also of her mother's death,
of the three preceding months, and of all that is con-
General Definitions 329
nected with her affection for her mother, and during
the fits all these remembrances are perfect. Do the
subjects who show us applications of these laws ; — and,
in my opinion, they are very numerous — do these sub-
jects know them ? Have they the idea of having such
an oblivion in connection with their somnambulism?
How very unlikely ! They would much rather have the
contrary idea, that of being obsessed by their remem-
brance like the psychasthenics.
The more hysterical paralyses are studied, the more
laws of a similar kind will be discovered. I have
observed to you that the accidents bear on functions.
It is true that these functions oftenest appear to be iden-
tical with those which the vulgar have themselves recog-
nized, the function of alimentation, the function of
walk, the function of the movements of the hand. In
this case, you will tell me, the paralysis might very well
be brought about by an idea, since the popular idea
coincides with the very limits of the paralysis. This is
true in general, simply because the popular ideas are
true. The great divisions of the functions correspond
to the great divisions of the organs, and the popular
analysis has been correct, that is all. But there are
some cases in which the popular analysis proves igno-
rant and in which hysterical paralysis analyzes the func-
tions much better than good sense does. Why are the ,
disturbances of speech accompanied with right-sided
hemiplegy? Why are there cases of hemianopsia?
How is it that there are distinct paralyses of monocular
vision and of binocular vision? Why are there dis-
turbances of accommodation? If you pass on to con-
330 The Major Symptoms of Hysteria
tractures, do you really believe that the patient has the
idea of rigidity without fatigue, without increase of the
temperature ? That he has the idea of that modification
of the reactions, of that slowness of the muscular shake ?
I am convinced, for my part, that hysterical contracture
has its own laws, quite peculiar to it, presenting us,
as I told you, a degradation of the contraction of the
striated muscles. All this is outside of the thought
of the subject. As I told you at the beginning, it will
be, later, a matter of astonishment that physicians should
have attributed to the caprice of the subject all the
psychological and physiological laws that will be dis-
covered in these various accidents.
Lastly, I insist on a third argument. These defini-
tions have a meaning only on condition that the words
"fixed idea" and "suggestion" are used in a particular
sense. This sense should be that, with hystericals,
ideas do not conduct themselves as with everybody.
It is of no use for me to represent to myself that I am
asleep; I do not, therefore, sleep. All these authors
imply tacitly that these ideas act in a special manner on
the mind and organism. I answer that it is this special
action that is the essential point ; it is this action that
constitutes hysteria, and you have not the right to make
a definition in which you tacitly imply what is essential.
Begin by defining what you call suggestion, and after-
wards you may say, if you choose and if it is true, that
hysteria is a disease due to suggestion. But, to define
suggestion, you will be obliged to introduce into your
definition certain new notions which are precisely those
I asked for.
General Definitions 331
;
IV
You will be obliged to recognize that these ideas
present themselves in special conditions, that they
develop out of measure because they meet with no coun-
terpoise in the mind, because they are isolated, owing to
a strange absent-mindedness of the subject ; in a word,
you will recognize the other stigmata, absent-minded-
ness and the retraction of the field of consciousness.
When you have once admitted this retraction of the field
of consciousness as one of the conditions of suggestion
itself, why should you maintain that it can produce noth-
ing but suggestions? Why should you not admit that
this disease of the mind may be manifested by some-
thing else? If this retraction has given too much
power to certain ideas, does it not produce, on the other
hand, some blanks ? Can it not isolate and emancipate
one function and suppress another from consciousness ?
We then arrive at another group of definitions in
which I range mine. They are definitions, in my
opinion, more profound, into which enter the phenomena
of dissociation of consciousness, such as is observed in
all hysterical disturbances. Suggestion itself is but a
case of this dissociation of consciousness. There are
many others beside the one in somnambulisms, in au-
tomatic words, in emotional attacks, in all the functional
paralyses. Many authors, Gurney, Myers, Laurent,
Breuer and Freud, Benedict, Oppenheim, Jolly, Pick,
Morton Prince, have thought like me that a place should
be made for the disposition to somnambulism. Was
not the somnambulic attack for us the type of hysterical
332 The Major Symptoms of Hysteria
accidents in 1889? "The disposition to this dissocia-
tion and, at the same time, the formation of states of
consciousness, which we propose to collect under the
name of hypnoid states, constitute the fundamental
phenomenon of this neurosis," said MM. Breuer and
Freud, of Vienna, in 1893.
The point which seems to me to be the most delicate
in this definition is to indicate to what depth this dis-
sociation reaches. In reality we might say that demen-
tias themselves are dissociations of thought and of the
motor functions. We must remember that, in hysteria,
the functions do not dissolve entirely, that they continue
to subsist emancipated with their systematization.
What is dissolved is personality, the system of grouping
of the different functions around the same personality.
I maintain to this day that, if hysteria is a mental
malady, it is not a mental malady like any other,
impairing the social sentiments or destroying the con-
stitution of ideas. It is a malady of the personal syn-
thesis, and I will take up again, very slightly modified,
the formula I have already presented. Hysteria is a
form of mental depression characterized by the retraction
of the field of personal consciousness and a tendency to
the dissociation and emancipation of the systems of ideas
and functions that constitute personality.
Let us leave too general discussions and come back
to a more clinical conception of things. The most
important problem is not for me to understand what
General Definitions 333
hysteria in general is, but to account for the practical
evolution of the accidents with such or such a person.
The difficulty we meet with, then, is a difficulty of local-
ization. How is it that with one person the hysteria
bears on the arm, with another on the stomach, and that,
with a third, it only reaches a system of ideas, which it
turns into a somnambulism ? It is on this search for an
interpretation proper to each subject that one should
dwell, to my mind, much more than on general quarrels
of definition.
The starting-point of hysteria is the same as that of
most great neuroses, it is a depression, an exhaustion of the
higher functions of the encephalon. All the psychological
operations do not present, as I repeat, the same difficulty.
There are some operations that are easy for all kinds of
reasons, first, because they are simple and only require
the union of a small number of elements; second,
because they are old, because their systematization
was the work of our ancestors and is inscribed in strongly
constituted organs. There are some other functions
that are difficult because, on the one hand, they are
very complex, because they necessitate the systematiza-
tion of an infinite number of elements, and because,
on the other hand, they are very new and require a
present synthesis, not yet inscribed in the organism.
Now, our nervous strength, which we do not know at all,
presents oscillations. When it is high, we easily accom-
plish the operations of the second group, we have an
extended consciousness, we turn back from no new
study or action.
But there are many circumstances in which this
334 The Major Symptoms of Hysteria
nervous tension is lowered, especially with those hered-
itarily predisposed. There are some physiological
periods, puberty for instance, at which the vital forces
seem to be busy elsewhere and to leave no great re-
source to the brain. There are diseases that, through a
thousand mechanisms, through local lesions, through
intoxication, through microbian infection, lower our
nervous tension. Even in normal functioning, physical
or intellectual fatigue is enough to produce momentarily
the same result. Lastly, — the fact is more difficult
to understand but incontestable, — emotion is character-
ized by this lowering of the nervous strength. Very
likely, in emotion, there is a great expense of nervous
strength necessitated by the new problem suddenly
set, and the emotional disturbance must come close
to that of fatigue. However it may be, our patients
have been exhausted through one of the preceding
causes. If hereditarily predisposed, they are enfeebled
by puberty, or they succumb to intoxication, fatigue,
or emotion. The diminution, the lowering of the ner-
vous tension, may bring about a general lowering of
all the functions, and especially of the highest. This
is what takes place in the psychasthenic neuroses, in
which the localization on a special point exists in a
rather slight degree.
With hystericals, in consequence of particular dis-
positions, the lowering of the nervous strength produces,
in some manner, a superficial retraction; there is,
as it were, an autotomy. Consciousness, which is no
longer able to perform too complex operations, gives
up some of them. There is, it is true, a general en-
General Definitions 335
feeblement, which manifests itself through the common
stigmata, but there is, above all, a localization of the
mental insufficiency on such or such particular function.
So we find again in hysteria the problem of localization,
which is of great importance in this disease.
No doubt, in a certain number of cases, the local-
ization is effected through suggestion. An idea sug-
gested from without attracts the thinking in one di-
rection or another, and brings about, besides, according
to laws the subject does not know, such or such auto-
matic functioning and such or such a loss of function.
This is only a particular case. The localization may
also be effected through a process akin to suggestion,
but which is not identical with it, according to the laws
of psychological automatism. I have often drawn your
attention to those individuals, who, having had an acci-
dent in certain circumstances and having been cured,
always recommence the same accident each time they
experience an emotion, though it has no relation with
the first. The man who was wounded by a railroad
engine has a delirium hi which he sees an engine coming
towards him. This is quite simple. Eleven years
afterwards, he sees his wife die, and he recommences
the engine delirium. Another has the tic of blowing
through one of his nostrils because he had a scab in
his nose, in consequence of a bleeding at the nose. He
recovers from his tic, but he recommences it now, be-
cause he loses his fortune, because his child is ill, etc.
Third law: The dissociation simply bears on a
function that, for some reason or other, has remained
weak and disturbed. Many of our patients become
336 The Major Symptoms of Hysteria
dumb after an emotion, but they were formerly in-
clined to stammer, their speech was quite insufficient.
A girl's right leg becomes paralyzed ; the reason is that,
in her childhood, her right leg was affected with rachitis.
In the case of another girl, the paralysis of a leg is due
to the fact that, in her childhood, the leg was affected
with a white tumour and remained long in bandage.
This remark relates specially to the very numerous
cases of associated hysteria: a disease of any kind
bearing on viscera, often an organic lesion of the
medulla or of the brain, enfeebles or disturbs some
function and it is on this function that the hysteric
emancipation is localized. So, in certain cases, hysteria
makes conspicuous some light symptoms of organic
diseases of the nervous system quite at their beginning
by exaggerating them beyond all measure. The fact,
for instance, was frequently observed in the cases of
tabetic vomiting associated with hysteric vomiting.
Fourth law : The function that disappears is the most
complicated and the most difficult for the subject.
This law applies chiefly to professional and social
paralyses.
Finally, fifth law: We remark a very curious fact,
which we recognize without always being able to account
for it. The dissociation bears on the function that was
in full activity at the moment of a great emotion.
There are here some physiological laws that cause the
chief disturbance to bear on this function, that make
it, probably through an association of ideas, through an
evocation of the emotion, the most difficult for the
subject.
General Definitions 337
It is the study of these laws, it is the search for these
conditions, that constitute the important part of the
study of hysteria. Leave the discussions of general
definitions; they are premature discussions, which
bear on purely verbal differences. Retain from these
lessons the importance that attaches to the study of the
psychological functions, the necessity of analyzing, in
each particular case, the mental state of the patient.
If these lectures have inspired you with some interest
for this kind of studies, if they can contribute to develop
in your beautiful country the researches of pathological
psychology, beside the researches of experimental
psychology, so brilliantly represented, I think you will
not have lost too much time in trying to understand a
barbarous language.
For my part, I deeply feel your kind attention and
reception, and I am proud of having had, for a few days,
the honour of teaching you and of being the colleague of
the masters of Harvard University.
INDEX
Abdomen, swelling of, among phe-
nomena of respiration, 263-264.
Absent-mindedness, 172, 296, 309-
311; rhythm of Cheyne-Stokes
and, 254.
Abulia, 315.
Accommodation, spasm of, 206-207,
329-
Aerophagia, phenomenon of, 260.
Alimentation, hysterical disturbances
of, 227 ff.; tics of, 264-269.
Allochiria, 183.
Alternation, stigma of, 302.
Amaurosis, unilateral, 168-169, 171,
188-195, 302.
Amnesia, retrograde, 37-43, 72; con-
tinuous, 72, 314; analysis of con-
tinuous, 72-74; the stigma of
somnambulism, 124-125.
Amnesias, graphic method for repre-
sentation of, 70-77.
Anesthesia, hysteric, in motor dis-
turbances, 124-126; description of
hysteric, 150-158; in paralyses,
150-158; difference between hys-
teric and organic, 162-163; change
in, during intoxication of subjects
of, 165; carried to high degree in
unilateral amaurosis, 189; theory
of anorexy through anesthesia of
stomach, 236-238 ; respiratory, 246-
247; stigma of, 272-276.
Anesthesias, mobility of, 163-164.
Anorexy, hysterical, 228-233; three
periods of, 230; theories of, 233-
234; motor agitations in, 239-241;
suppression of feeling of fatigue in,
241-242; paralyses resulting from,
243-244-
Anosmia, hysterical, 249.
Apepsia hysterica, Gull's, 228.
Aphasia, 209; distinction between
hysterical dumbness and, 215-217;
motor, 218-219.
Aphonia, 317.
Asphyxia, hysterical, 247-248.
Aspiration, tics of, 266.
Astasia-abasia, 177-181, 217.
Astruc, 14.
Attention, incapacity of, 314.
Automatism, ambulatory, 44-45 (see
Fugues); of writing, 212; verbal,
225.
Azam, Dr., case of double personality
reported by, 78-82.
B
Babinski, on reflexes, 147, 148, 150;
mentioned, 178, 279; definition of
hysteria by, 325.
Ballet, 205, 219, 277.
Barks, hysterical, 262.
Bastian, Charlton, quoted, 175-176;
work by, 322.
Bawl, the hysterical, 272.
Beauchamp, Miss, a case of complex
personality, 85.
Benedict, 331.
Bernheim, 4, 17, 192, 193, 327; defi-
nition of hysteria by, 325.
Binet, 4.
Bladder, troubles of function of, 244.
Blindness, hysterical, 185 ff.; cases of,
186-187.
Bloch, apparatus devised by, 350.
Blocq, form of ' hysterical paralysis
pointed out by, 177.
Blood, vomiting of, 268-269.
Borel, 186.
Bourru, 83.
Brachet, 15, 320.
Breuer, 4, 331, 332.
Brewster, experiment of, 192-193.
339
340
Index
Briquet, 16, 151, 156, 167, 210, 255;
quoted on hysteric fits, 102.
Brissaud, 4.
Bristow, 205.
Broca, 215.
Brodie, English physician, 15-16,
140, 176; work of, on local ner-
vous affections, 131.
Bulimia, 264-265.
Burcq, 167, 236, 300; quoted on
anesthesia and muscular weakness,
183-
Burot, 83.
C
Cartaz, on hysterical dumbness, 210,
214.
Catalepsy, form of somnambulism
called, 33.
Chairou, 249.
Charcot, T. M., 3, 4, 12, 16-17, 20-21,
I31. 140, 144, IS1. I53. 161-162,
177, 198, 210, 233; quoted regard-
ing fugues, 60 ; cases of double per-
sonalities of, 74 ; on motor agitations,
121,122; helicopode and helcopode
gaits of, 146, 174; case of hysteri-
cal dumbness studied by, 211; the
anesthesia of, 273-276; definition
of hysteria by, 324, 325.
Cheeks, spasms of, 265.
Cheyne-Stokes, rhythm of, 252-254.
Chorea of Sydenham, 123.
Choreas, rhythmical, 121-123.
Clonus of foot, 147; sign of, 149-150.
Consciousness, the field of, 303-304;
contraction of field of, 304-311, 316,
332; dissociation of, 331-332.
Contraction of voluntary movements,
295-296.
Contractures, hysteric, 131 ff.; errors
resulting from, in diagnoses, 132-
133; causes and cure of, 133-135;
miraculous cures and, 134; author's'
hypothesis concerning, 136-137;
phenomenon of anesthesia in, 273-
274.
Convulsive attacks, 94-104; analogy
between somnambulisms and, 95-
96; false theories concerning, 98-
99; difference between epileptic
fits and, 100, no; distinguishing
characteristics of, 100-104.
Coprolalia, 225.
Coriat, H., paper by, 55.
Corson, Mrs. C. Rollin, 303.
Coste, works of, 249.
Cough, the hysterical, 260-261.
Coulson, 131.
Courtney, Dr. J. M., paper by, cited,
58-59-
D
Dana, Dr., cited, 66.
Danilewsky, works of, 249.
Deafness, hysterical, 183-184.
Dejerine, observations of functional
hemianopsia by, 200.
Delbceuf, 4.
Despine, Dr. (d'Aix), 139-140, 236.
Devil's claws, 151, 272-273.
Diaphragm, paralysis of, 254-257.
Digestion, hysterical disturbances of,
227 ff.
Diplopy, monocular, 207.
Dipsomania, polydipsia distinguished
from, 265.
"Diseases of Memory," Ribot's, 78.
Dissociation of consciousness, 331-332.
"Dissociation of a Personality,"
Prince's, 67.
Double personalities, 66 ff.; rarity of
cases of, 67; the first type of, the
Lady of MacNish, 68-69; an^
reciprocal somnambulisms, 72-77;
the dominating somnambulism in,
77 ff.; case of Felida X., 78-81;
the group of complex cases, 83-86;
case of Marceline, an artificial
double personality, 86-91; os-
cillation of mental activity in, 92.
Drinking, mania for, 265.
Dubois, Dr., 323.
Duchenne (de Boulogne), 15, 140.
Duchesne, Marguerite Franooise, case
of, 210.
Dumbness, hysterical, 209-215.
Dumontpallier, 282, 300.
Dutil, 165.
Dyschromatopsia, 204.
Index
34i
Eating, mania for, 264-265.
Echolalia, 225.
Electricity, action of, on sensibility,
167; power of speech restored by,
210.
Emotional disturbances, 314.
Equivalences, 298, 301-302.
Eructation, tics of, 266.
Eyes, disturbances in motion of the,
205-207. See Vision.
Falsehood in hysteria, 278-279.
Fancher, " Mollie," double personal-
ities of, 84-85.
Felida X., story of double personal-
ity of, 78-81.
Fere, Dr., 4, 6; observations of, on
hysterical paralyses, 141-142; quoted
on hysterical paralyses, 175.
Fits, hysteric, 94 ff.; false theories
about, 98-99; difference between
epileptic and, 100, no; character-
istics of, 100-104.
Fixed idea, theory of, in anorexics,
234-235; importance of, in certain
hysterical accidents, 324-325; have
no relation to the medical form of
the accident, 328.
Flees, Dr., box of, for eye-testing,
190-192.
Flights. See Fugues.
Flourens, 249.
Forel, 4.
Francais, Henry, 239.
Franck, works of, 249.
Freud, Professor, 4, 145, 331, 332.
Fugues, hysterical, 44-45; examples
of, 45-61; analogy between mo-
noideic somnambulisms and, 54-59 ;
differences between somnambu-
lisms and, 59-61; artificial repro-
duction of, 112.
Gelle, 220.
Georget, 15, 151.
Goodhart, "Multiple Personality" by,
67.
Grasset, 4, 324.
Gull, W., anorexy described by,
228.
Gurney, 331.
H
Hallion, study of vascular reflexes by,
160.
Hallucinations, connected with som-
nambulisms, 32-37, 59-60; lack-
ing in fugues, 60.
Harris, Wilfred, on hysterical hemi-
anopsia, 200-201.
Hauron, Ducos de, 194.
Helicopode and helcopode gaits, 146,
174.
Hemianesthesia, 153-154.
Hemianopsia, hysterical, 199, 329;
compared with hysterical hemiplegy,
200-20 i.
Hemiplefjy, 142-143; organic and
hysteric, 146-147; hysterical hemia-
nopsia compared with, 200-201;
a case of hysterical, 212.
Hiccough, the hysterical, 259-260.
Huchard, 176.
Huf eland, 15.
Hypnogenic points, 108-109, "3-
Hypnotism, case of double personality
treated by means of, 86-89; arti-
ficial somnambulisms called, 114;
question concerning hysteric som-
nambulism and, 114-116.
Hysteria, evolution of studies about,
13 ff.; derivation of the word, 15;
notice of Charcot's work in, 16-17;
the psychological type of, 18-20;
somnambulism the typical form of
accidents of, 22-24; study of the
stigmata of, 270 ff.; suggestibility
the most important stigma of, 285-
292; other stigmata of, 293 ff.;
r6sum6 of typical symptoms of, 317-
321; various definitions of, 321-
326; discussion of definitions, 326-
332; author's formula of, 332.
Hysterogenic points, 98-99, 113.
342
Index
Idea. See Fixed idea.
Inanition, hysterical, 228-229; pe-
riod of, in hysterical anorexy, 232.
Incapacity, of attention, 314; of
beginning and stopping, 315.
Incompleteness, the feelings of, 312-
3*3-
Ingenieros, Jose, book by, 322.
Insensibility, phenomena of, in tics,
124-125; examination of, in
paralyses, 150-158; vanishing of,
during intoxication, 165.
Insomnia, 315.
Inspiration tics, 259.
"Intelligence," Taine's, 78.
Intestine, paralysis of, in disturb-
ances of alimentation, 243-244.
Intoxication and anesthesia, 165.
Jaccoud, form of hysterical paralysis
pointed out by, 177.
James, William, cited, 175.
Janet, Jules, 162, 165.
Jaws, spasms of, 265.
Jolly, F., 188, 331.
Kaempfen, case of retrograde am-
nesia of, 71.
Kissel, case of anorexy cited by, 229.
Koenig, case of ophthalmoplegy
of, 205.
Kussmaul, 210.
Kuttner, patient of, with vomiting
of blood, 268.
"Lady of MacNish," story of, 68-
69; analysis of case, 72-77; a
type of so-called "reciprocal
somnambulism," 74.
Landolt, 186.
Landouzy, 15, 151.
Lapses of the mental functions,
313-316.
Lasegue, 131, 161, 168, 171-172,
233, 320, 327; anorexy described
by, 228.
Laughter, hysterical, 261.
Laurent, 331.
Laziness, hysterical state of, 314.
Lebreton, 205.
"Lecons du Mardi," Charcot's,
219.
Lepine, 219, 249.
Lepois, Charles, 14, 185-186.
Lermoyez, M., 246—847.
Limbs, disturbances in motor func-
tions of, 117-119.
Localization, the laws of, 333-337.
Lowering of the mental level, the,
316.
M
Mabille, case of Louis Vivet pub-
lished by, 83.
MacNish, Dr., 67, 68.
Macropsia, 207.
Malebranche, 291.
Marceline, the case of, 87-91.
Marie, Dr. Pierre, 4, 209.
Marion, Elie, case of, 225.
Mathieu, A., 267, 268, 325.
Memory, loss of, connected with
somnambulism, 3 7-43 ; absence of,
3*4-
"Mental State of Hystericals,"
Janet's, 303.
Merycism, 266.
Mesnet, 4.
Meteorism of the abdomen, 263-
264.
Micro psia, 207.
Miracles, performance of religious,
accounted for, 134.
"Miracles of Deacon Paris," Mont-
geron's, 134, 210.
Mitchell, S. Weir, 67; case of
double personality of, 74-77.
Mcebius, 4, 277; definition of hys-
teria by, 325.
Monoplegy, 144.
Montgeron, Carre de, 134, 210.
Morax, 206.
Mosso, 249, 254.
Index
343
Motor disturbances of limbs, 117-
119.
"Multiple Personality," Sidis and
Goodhart's, 67.
Mil nster berg, Professor, 3.
Mutism, hysterical, 209-215.
Myers, Arthur, 84, 331.
N
Narrowing of the visual field, 195-
2OI.
Neuroses, traumatic, study of, 140.
(Esophagus, spasms of the, 243-
244, 266.
Ophthalmoplegy, 205-206.
Oppenheim, 140, 224, 331; defini-
tion of hysteria by, 325.
Pachon, works of, 249.
Page, W., 176.
Paget, 131.
Paralyses, hysteric, 138-139; causes
of, 140-142; varieties of (hemi-
plegy, paraplegy, monoplegy,
paralyses of the trunk), 142-144;
diagnosis of, 145-150; difference
between organic paralyses and,
146; systematic, 178; of diges-
tive organs in disturbances of
alimentation, 243-244 ; respira-
tory, 246 ff. ; of the diaphragm,
254-257; phenomenon of
anesthesia in, 273-274.
Paraplegy, 143.
Pare', Ambroise, 14.
Parinaud, 186, 192, 193, 206, 207.
Pawlof, 237.
Personalities, double. See Double
personalities.
Pharynx, spasms of the, 265.
"Philosophy of Sleep," MacNish's,
68.
Photophobia, 205.
Pick, A., 295-296, 331.
Pitres, 4.
Polydipsia, 265.
Polyopy, 207.
Polypnoea, respiration in cases of,
2SS-256. 257-258.
Polyuria, 265.
Pomme, 14.
Prince, Morton, 4, 331; cited con-
cerning double personalities, 67;
observations of Miss Beauchamp,
85-
Ptyalism, 266.
Railway spine, 140.
Ramadier, 83.
Recruits, eye tests for, 189-192.
Reflexes, 147; cutaneous, 148;
signs of, 149; pupillary, 150, 189;
absence of modification of, 160-
162.
Regnard, 192.
Regurgitation, 266.
Reproduction of hysteric accidents,
110-115.
Respiration, tics of, 245 ff. ; paral-
ysis of, 246 ff. ; alternating see-
saw, 255.
Retraction of field of consciousness,
304-311, 316, 332.
Revery, hysterical state of, 314.
Revillod, 210.
Reynolds, Mary, case of double per-
sonality, 74-77.
Reynolds, Russell, 140.
Rhythm of Cheyne-Stokes, 252-
254.
Ribot, Professor, 3, 4; on double
personality, 78.
Richer, Paul, 4, 131.
Richet, Charles, 4, 249, 277.
Robertson, Argyll, 150.
Roux, J. C., 267, 268, 335.
Salivation, tics of, 265.
Salute, the, in motor agitations, 121.
Saulle, Legrand du, 15, 83, 277, 279.
Index
Sauvage, 14.
Seglas, 177, 225.
Sensibility, disturbances of, 249-251.
Sensitiveness, modifications of, dur-
ing induced somnambulisms, 166-
167.
Sidis, B., "Multiple Personality"
by, 67.
Sigh, the hysterical, 259.
Simulation, perpetual, so-called,
277-278.
Sitieirgia, 229.
Sitiophobia, 229.
Sleep, fits of, examined as an ac-
cident of hysteria, 104-109.
Smell, disturbances of sense of, 183.
Snellen, letters of, for eye-testing,
190.
Sollier, 219, 236.
Somnambulisms, definition of, 24;
illustrative cases of monoideic,
26-32; characteristics of, 32-37;
analogy between fugues and, 54-
59; differences between fugues
and, 59-61 ; polyideic, 61 ; illus-
trative cases, 61-64; emancipa-
tion of feelings and emotions in,
64-65; reciprocal, 72-74; cases
of, 74-77; dominating, 77, 81-
82; complex (double and re-
ciprocal), 83; analogy between
convulsive attacks and, 95-96;
connection between fits of sleep
and, 104-109; artificial, or hyp-
notism, 110-115.
Spasms of jaws, cheeks, and of
pharynx, 265.
Speech, troubles of, 208 ff . ; tics of,
224-225; automatic, 225; eman-
cipation of function of, 226.
Spitting, tics of, 265.
Stammering, 217.
Stigmata, problem of, 271 ff.; divi-
sion into proper and common,
294; the common, 311-312.
Strabismus, 206.
Strumpell, definition of hysteria by,
325-
Subconsciousness, phenomenon of,
296-297.
Suggestibility, 270 ff. ; the most
important mental stigma of hys-
teria, 292.
Suggestion, mental phenomenon
of, 279 ff. ; distinct meaning of,
279> 33° > description of principal
facts of, 279-281; difference be-
tween normal phenomena and,
283-285; the conditions of, 285-
286.
Swelling of abdomen, 263-264.
Sydenham, 14, 18, 151, 271; chorea
of, 123.
T
Taine, on double personality, 78.
Tardieu, 277.
Taste, disturbances of sense of, 183.
Tics, 119-123; characteristics of,
123-128; hysteric anesthesia in,
124-126; of speech, 224-225; of
inspiration, 259; expiratory, 260-
264; complex phenomena of, 262-
264; of perpetual spitting and
salivation, 265 ; of eructation, 266.
Todd, study of traumatic neuroses
by, 140.
Touch, disturbances of sense of,
182-183.
Tourette, Gilles de la, 4, 199, 224,
237; work of, cited, 248.
Tours, Moreau de, 7.
Transfers, 298-300.
Tremors, phenomenon of, in hys-
teria, 129-131.
Unity, need of, under diversity
of hysterical phenomena, 270-
272.
V
Vascular reflexes, 160.
Villermay, Louyer de, 15, 151.
Vision, troubles of, 185 ff., 339;
dissociation of monocular and
binocular, 193-195; narrowing
of the visual field, 195-201;
disturbances in movements of the
eyes, 205-207.
Index
345
Vivet, Louis, case illustrating com-
plex somnambulisms, 83-84.
Voice, troubles with. See Speech.
Voisin, Jules, 83, 165.
Vomiting, hysterical, 266-268, 301,
325, 336; of blood, 268-269.
W
Walks, helicopode and helcopode,
146, 174.
Wallet, Dr., article by, 239-240, 241
Walton, Dr. G. L., 184.
Watson, English surgeon, 210.
Will, disturbances of the, 314-315.
Witt, 14.
Word-blindness, 219.
Word-deafness, 219-2*1.
Yawn, the hysterical, 259.
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